Form 78-010-10 - Affidavit Of Sale Under Lien Form printable pdf download

AFFIDAVIT OF SALE UNDER LIEN

Form 78-010-10

THE STATE OF MISSISSIPPI, COUNTY OF ________________________________________, DATE __________________

________________________________ OR ______________________________ OR _______________________________

(Name of Lienholder)

(Pres., V. Pres., Sec-Treas.)

(Manager)

owner and holder of an indebtedness owed by _______________________________________________________________

(Name of Person Owning Indebtedness)

of ___________________________________________________ secured by lien on Motor Vehicle described in certificate of

(Address)

Title Number _____________________, Vehicle Identification Number (VIN) _______________________________________

Default having been made, the undersigned foreclosed the lien in the manner provided by law and by the terms of the lien

instrument and sold the vehicle described to ________________________________________________________________

(Name of Buyer)

________________________________________ on ______________ at ________________________________________

(Address)

(Date)

(Place of Sale)

for $_________________________________

(Consideration)

The undersigned states that all applicable laws of the State of Mississippi, as well as the applicable laws of any other state

where the Vehicle may have been repossessed, have been fully complied with, and the undersigned further states and

guarantees that the purchaser has good Title to the Vehicle which is warranted subject to the following liens:

___________________________________, __________________________________, ____________________________

AND AFFIANT FURTHER STATES;

Federal law and State law requires that you state the mileage in connection with the transfer of ownership. Failure to

complete or providing false statement may result in fines and/or imprisonment.

I, ___________________________________, state that the odometer now reads __________________ (NO TENTHS) miles and to the

best of my knowledge that the actual mileage of the vehicle described herein, unless one of the following statements is checked:

__ (1) I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits.

__ (2) I hereby certify that the odometer reading is NOT the actual mileage. WARNING – ODOMETER DISCREPANCY

_____________________________________________

_______________________________________________

(Printed Name of Seller)

(Printed Name of Buyer)

_____________________________________________

_______________________________________________

(Signature)

SUBSCRIBED AND SWORN TO BEFORE ME THIS ________ day of _______________________________, 20_______.

_______________________________________________

SEAL

(Notary Public)

Title Bureau, P.O. Box 1383 Jackson, MS 39215

Phone 601-923-7200 FAX 601-923-7224

Form 78-010-10 - Affidavit Of Sale Under Lien Form

Related Articles

Related forms

Related Categories