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Get West Virginia Cosmetic Total Loss 2011-2024

Is necessary in order to legally and safely operate the motor vehicle on the roads and highways of this state. I hereby certify under penalty of fines and/or imprisonment, that the statements made herein are correct to the best of my knowledge and belief. Name of Insurance Company Signature of Representative (X) MUST BE AN ORIGINAL SIGNATURE Indicate Damage Below: * This form must be accompanied by the owner’s title and the required $10.00 fee. ANY ALTERATIONS OR ERASURES WILL VOID THIS FORM.

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