Fillable Printable Affidavit of Correction Form - Mississippi

Affidavit of Correction Form - Mississippi

AFFIDAVIT OF CORRECTION

Title Bureau P. O. Box 1033 Jackson, MS 39215 www.dor.ms.gov Phone 601-923-7643 FAX 601-923-7224

Date: ___________________________

To Whom It May Concern:

The strikeover on the assignment of the attached Manufacturer’s Certificate of Origin or Certificate of Title for

the following described motor vehicle:

Year: ________________ Make: ________________________ Model: _________________________

Vehicle Identification Number (VIN): ____________________________________________________________

was made due to the following reason(s):

___ Typographical error ___ Assignment placed in dealer assignment in error

___ Customer changed mind ___ Notary Public placed signature in wrong space

___ Seller signed their name incorrectly ___ Purchaser’s name misspelled

___ Seller assigned title to wrong party ___ Seller made strikeover in purchaser’s name

___ Other: _________________________________________________________________________________

___________________________________________________________________________________________

Sworn to and subscribed before me this _______day of __________________________________, 20________.

_________________________________________ ______________________________________________

Signature Signature

Notary

__________________________________________ Seal

Notary Public’s Signature

IMPORTANT: The person(s) who was required to complete the assignment where the correction has been made

must complete this form. This form cannot be used when information has been blocked out by erasure or the use

of correction fluid/tape. In these cases, replacement documents must be obtained. This form cannot be used to

correct an odometer reading, a purchase date, or an incorrectly recorded lien, or security interest holder. For an

incorrectly recorded lien or security interest holder, a release of lien or security interest must be obtained by the

incorrectly recorded lien or security interest holder and submitted.

Form 78-008-10