Form Mv-18e Affidavit - Affidavit To Support A Request For Correction Of The Vin Recorded On A Georgia Vehicle Title And Registration
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2MV-18E Affidavit (Rev. 11-2009)
Affidavit to Support a Request for Correction of the VIN
Recorded on a Georgia Vehicle Title and Registration
PART 1 Except for signatures, type, legibly print by hand or electronically complete and print in blue or black ink and submit.
Personally appearing before the undersigned officer, duly authorized by law to administer oaths, comes
_____________________________________________________________, who deposes and states under oath the following:
(Full, Legal Name)
1.
I am over the age of majority and give this affidavit on the basis of my personal knowledge of facts and circumstances
surrounding a _______________ __________________________ ________________________________________
(Vehicle Year)
(Vehicle Make)
(Vehicle Identification Number)
2.
I am the owner of the motor vehicle identified on Certificate of Title #________________________________________
(Certificate of Title Number)
3.
Registered with ______________________
____________________________________________________, and
(License Plate/Tag Number)
(License Plate Category – i.e. Passenger, Prestige, College, etc.)
4.
The vehicle identification number (VIN) is incorrectly recorded in the files of the Department of Revenue, Motor Vehicle
Division. The incorrect and correct vehicle identification numbers are recorded below.
5.
Vehicle Identification No. (VIN) ____________________________
_____________________________________
(Incorrect VIN)
(Correct VIN)
I understand that the Department or County Tag Agent is correcting the vehicle record, registration and title based in part on the
information provided in this affidavit. Therefore, I agree to defend, indemnify and hold harmless, the State of Georgia, Department
of Revenue, Processing Center-Motor Vehicle, County Tag Agents, their commissioners, directors, officers, and employees, from and
against any and all claims, demands, liabilities, losses, costs or expenses, including attorneys’ fees, due to liability to a third party or
parties, for any loss due to any injury arising out of or resulting form the correction of this vehicle record, registration and title based
on the information contained in this affidavit.
PART 2
Owner’s Certification
X___________________________________________
_____________________________________________________
Owner’s Signature
Owner’s Driver’s License/State-Issued ID Card # & State of Issue
____________________________________________
____________________________________________________
Owner’s Street Address
Printed Company or Business Name (if Applicable)
____________________________________________
____________________________________________________
Owner’s City, State, Zip
Position with Company or Business (if Applicable)
____________________________________________
____________________________________________________
Owner’s Telephone # Including Area Code
Company or Business Address (if Applicable)
PART 3
Notary Public’s Acknowledgement
Sworn to and subscribed before me this _______________ day of __________________________________, ______________.
(Day)
(Month)
(Year)
_____________________________________________
_______________________________________, ___________.
Signature and Seal or Stamp of Notary Public
Date My Commission Expires
_____________________________________________
___________________________________________________
Printed Name of Notary Public
Driver’s License or State-Issued ID Card # of Notary Public
_____________________________________________
___________________________________________________
Street Address of Notary Public
Telephone # and Area Code of Notary Public
_____________________________________________
City, State and Zip Code of Notary Public
Important: The Department of Revenue and County Tag Agents reserve the right to deny the correction of any motor
vehicle record, certificate of title and registration. During the correction of a VIN, if the Department or a County Tag
Agent determines that a motor vehicle record, registration and/or title record exists for the correct VIN, the owner will
have to comply with additional requirements.
Refer to the reverse side of this form for additional information and requirements.
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