Not the seller's form, and worth understanding anyway. It is how an insurer takes ownership of a written-off car when the owner has accepted the settlement and then never sent the signed title back. A private owner cannot file it - but if you have taken a total-loss payment and left the paperwork in a drawer, this is what is happening next.
Written against MV-4IS (2-25), issued under 75 Pa.C.S. 1161.
If your insurer has written a car off and you still hold the certificate, send it. Holding on to it does not preserve any ownership - it only means the salvage certificate issues from a form you never saw, with an odometer figure somebody else wrote.
Two documents, and they are not the same thing. Take the blank MV-4IS from the pa.gov copy so you get the revision that is current today.
This is the actual MV-4IS, rendered from the PDF the Pennsylvania Department of Transportation publishes and completed end to end: letterhead, every field, and the blocks at the foot.
Amber — you write it
Grey — not yours to fill
Numbered — explained below
The real MV-4IS, completed by an insurance company that could not get a signed title back after a total loss. There is no amber block for a vehicle owner anywhere on it - the whole form is the insurer's, which is exactly the point.
Field by field
Every line, in the order you meet it
1
The vehicle verifier fills this in
Section A, the company
The insurance company's name and full street address.
Watch out: Only an insurance company can be the applicant. An adjuster, a salvage yard or an owner cannot use this form at all.
2
The vehicle verifier fills this in
Section B, the vehicle and the money
The owner's name, title number, VIN, year, make and body style, then the amount paid to the customer and the sales tax due on it.
Watch out: Read your own name on that line if you are ever sent a copy. It is the last document that names you as owner of the car.
3
The vehicle verifier fills this in
Section B, the tax rate
6% of the settlement, unless the resident is in Allegheny County at 7% or the City of Philadelphia at 8%.
Watch out: The same three rates that apply to a private buyer. Pennsylvania does not have a separate salvage rate.
4
The vehicle verifier fills this in
Section C, the odometer
Six printed boxes, whole miles only, and two ticks beside them for a reading past the odometer's mechanical limit or one that is not the true mileage.
Watch out: Where the owner never returned a signed title, this figure is whatever the insurer recorded when they inspected. That is a reason to return the title rather than not.
5
The vehicle verifier fills this in
Section D, the four boxes
Documentation held and available on request; at least two written attempts to obtain the title; the settlement payment mailed or delivered; and the owner's acceptance of the total-loss settlement.
Watch out: All four are conditions, not options. The certification underneath carries a third-degree misdemeanour penalty with a fine up to $2,500.
At a glance
What goes where
On the form
What to put in it
Section A, insurance company information
Name of the insurance company and its full street address.
Section B, vehicle description
The owner's name, title number, VIN, year, make, body style, the amount paid to the customer, and the sales tax due - 6%, or 7% for a resident of Allegheny County and 8% for a resident of the City of Philadelphia.
Section C, odometer reading
The reading in a row of boxes with no tenths, and two boxes: mileage in excess of mechanical limits, and a reading that is not the actual mileage.
Section D, certification
Four tick boxes the insurer has to be able to stand behind, then a printed certification, an authorised signer's printed name and signature, a telephone number and a date.
What gets this one rejected
•An application before the 30 days have run. It may only be used where the company is unable to obtain the properly endorsed certificate of title or certification of salvage within 30 days following oral, written or electronic acceptance by the vehicle owner of an offer in settlement of a total loss.
•Using it where the owner never accepted the settlement. The form excludes that case in its opening paragraph.
•Using it on a stolen vehicle. It does not apply to a vehicle that has been driven or taken without the consent of the owner.
•An insurer who has not chased the title. Two of the tick boxes are that at least two written attempts, mailed or delivered, were made, and that the settlement payment was mailed or delivered.
•Anyone other than an insurance company filing it. There is no owner's block on the form at all.
Rules that decide whether it is accepted
•What it means for you. Accepting a total-loss settlement and then not returning the assigned title does not keep the car in your name indefinitely. After 30 days the insurer can take the salvage certificate without your signature.
•The tax still gets computed. Section B carries the amount paid to the customer and the sales tax on it, at the same 6, 7 and 8 per cent rates a private buyer pays.
•No fee. The form states that no fee is required.
•The documents stay with the insurer. One of the tick boxes is an acknowledgement that the supporting documentation must be in the insurance company's possession and available on departmental request, rather than submitted with the application.
Every line here was read off MV-4IS (2-25) itself —
the PDF is here — and off the Pennsylvania Department of Transportation pages.
This is plain-language help with a form, not legal advice, and where our wording and the agency's differ,
theirs governs.
