Form Vp-02 - Repossession Affidavit
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1555 Wright Way
Carson City, NV 89711-0700
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas area (702) 486-4DMV (4368)
Rural Nevada or Out of State (877) 368-7828
REPOSSESSION AFFIDAVIT
Please print or type
I, ____________________________________ being first sworn deposes and says I am the legal
Lienholder as shown on the Nevada Certificate of Title
Owner and a Lienholder of the vehicle described below and in the name of
Registered Owner _________________________________________________________________
Registered Owner _________________________________________________________________
Described as follows:
Vehicle Identification Number
Year _________ Make ___________________ Model __________________
I certify that all provisions of Nevada Revised Statutes 482.516 through 482.518 have been complied
with, and make this affidavit for the purpose of satisfying the Nevada Department of Motor Vehicles. I
also hereby release, discharge and agree to hold harmless the Nevada Department of Motor Vehicles
of and from any and all liability to anyone whomsoever which may arise by reason of any contest of
the validity of the repossession herein referred to, or the validity of the repossession of the vehicle
under provisions of the conditional contract in the manner prescribed in Nevada Revised Statutes.
Nevada Driver’s License, Identification Card Number, Date of Birth, or FEIN for businesses number:
________________________________________________________________________________
Physical Address
_______________________________________________________________________________
City
State
Zip Code
Mailing Address
_________________________________________________________________________________
City
State
Zip Code
Printed Full Legal Name of Business or Individual(s) _______________________________________
State of Nevada, County of ____________________
Subscribed and sworn to before me on ___________
Date
By __________________________________________
Notary Stamp
Signature of Affiant
______________________________________________
Notary Public or Authorized Nevada DMV Representative
Signatures must be originals. Photocopies are not acceptable.
VP-020 (Rev. 6/2012)
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