Fillable Printable Affidavit To Support an Application for a Certificate of Title

Affidavit To Support an Application for a Certificate of Title

EGAL NOTICE: (A) Any alteration or erasure voids the assignment. Section 32-8-12, Code of Alabama 1975, provides: “A person is guilty of a class C felony who,

with fraudulent intent, alters or forges an assignment of a certificate of title, on a certificate of the title or on a form the Department prescribes.’

his form may ONLY be used to make corrections to information incorrectly stated in the title assignment.

YPE OF CORRECTION: (mark one)

អ

ssignment on Manufacturer’s Statement of Origin (Motor Vehicle Dealer only)

អ

ssignment of Title by Registered Owner

អ

e-Assignment of Title by Licensed Motor Vehicle Dealer

ASSIGNMENT NUMBER BEING CORRECTED (if applicable):

________________________________________________________________________

(FIRST RE-ASSIGNMENT BY LICENSED DEALER, ETC.)

CORRECTED ASSIGNMENT / RE-ASSIGNMENT SUPPLEMENT TO: (check one and provide Title Number)

អ

Alabama Certificate of Title No.: __________________________

អ

_________________ Certificate of Title No.: ________________________

(FOREIGN STATE)

អ

C.O. or M.S.O. ________________________________________________________________________________________________

NAME OF ORIGINAL (FIRST) DEALER AND ADDRESS (CITY & STATE)

VEHICLE IDENTIFICATION NUMBER (or Serial Number) __________________________________________________________________________

SELLER’S REASON FOR CORRECTION: ___________________________________________________________________________________

____________________________________________________________________________________________________________

FEDERAL and State Law requires that you state the mileage in connection with transfer of ownership. Failure to complete ODOMETER STATEMENT or

providing a FALSE STATEMENT may result in fines and/or imprisonment.

— NOTICE: ANY ALTERATION OR ERASURE VOIDS THE ASSIGNMENT and all assignments that follow —

CORRECTED ASSIGNMENT BY REGISTERED OWNER/RE-ASSIGNMENT BY LICENSED DEALER — SELLING DEALER’S STATE LIC. NO.

____________________

I/we warrant this Title and certify that the vehicle described herein has been transferred to the following:

Name(s):

_____________________________________________ Address: __________________________________________________

I certify to the best of my knowledge that the ODOMETER READING is the ACTUAL MILEAGE of the vehicle unless one of the following statements is checked:

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1. The mileage stated is in excess of its mechanical limits.

___________________

TENTHS

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2. The odometer reading is not the Actual Mileage. —

ODOMETER READING

WARNING — ODOMETER DISCREPANCY

SIGNATURE(S) OF BUYER(S): X

_____________________________________ OF SELLER(S): X _______________________________________

PRINTED NAME(S) OF BUYER(S): _______________________________________________ OF SELLER(S): _________________________________________

LIENHOLDER TO BE RECORDED AND SHOWN ON NEW TITLE: (IF NONE, STATE “NONE”)

NAME OF 1ST LIENHOLDER:

________________________________________ ADDRESS: ___________________________________________

____________________________________________________________ ___________________________________________________

Should buyer and seller sign at different times, their signatures must be notarized separately.

Before me personally appeared

___________________________________________ (Name of Seller(s)/Buyer(s) (type or print) who by me duly sworn upon oath

says that the statements set forth above are true and correct. Subscribed and sworn to before me this

_________ day of ___________________, ________.

(Year)

Signature of Notary

___________________________________________________

Notary Public for _________________________ County, State of _________________

My Commission Expires _________________________________________________

Before me personally appeared ___________________________________________ (Name of Seller(s)/Buyer(s) (type or print) who by me duly sworn upon oath

says that the statements set forth above are true and correct. Subscribed and sworn to before me this

_________ day of ___________________, ________.

(Year)

Signature of Notary

___________________________________________________

Notary Public for _________________________ County, State of _________________

My Commission Expires _________________________________________________

ORIGINAL SIGNATURES REQUIRED ON FORM

ABAMA

PARTMENT OF

VENUE

Affidavit of Correction to a Document

To Support an Application for a Certificate of Title

Date of Sale

/ /

VT: 5-7

Rev. 12/12

ALL AREAS MUST BE COMPLETED

CAUTION:

READ CAREFULLY

BEFORE YOU

HECK BLOCK