Fillable Form T-214 - Purchaser'S Statement Of Fact printable pdf download

Form T-214 - Purchaser'S Statement Of Fact

Download a blank fillable Form T-214 - Purchaser'S Statement Of Fact in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form T-214 - Purchaser'S Statement Of Fact with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

T-214 (Rev. 08-2005)

Web & MVD Manual

Purchaser’s Statement of Fact

This is to certify that I/we,

_____________________________________________________________________________________

(Purchaser(s)’ Full Legal Name(s) – First, Middle & Last)

______________________________________________________________________________________

(Purchaser(s)’ Street Address Including City, State & Zip)

purchased or acquired ownership of the following described vehicle:

______________________________

__________________________________________________

(Year Model & Make of Vehicle)

(Vehicle Identification Number - VIN)

from

________________________

:_________________________________________________________________________

(Date)

(Seller(s)’/Transferor(s)’ Full Legal Name(s) – First, Middle & Last)

____________________________________________________________________________________________________________

(Seller(s)’/Transferor(s)’ Street Address Including City, State & Zip)

This is to certify that the sale or ownership conveyance of this vehicle is made in good

faith and is not for the purpose of circumventing the provisions of §40-2-136 of the

Official

Code

Georgia

Annotated

relating

habitual

violators.

The

seller(s)/transferor(s) of this vehicle will be deprived of custody and control of this motor

vehicle as the result of this sale.

I/we am aware of the facts contained in this Statement of Fact and further agree to

idemnify the Department of Revenue for any and all losses, which may occur from facts

contrary to those contained in this statement after a title is issued.

Sworn to and subscribed before me

___________________________________________

(Purchaser(s)’/Transferee(s)’ Printed/Typed Name(s)

this

day of

_____

_____________, ________

___________________________________________

(Day)

(Month)

(Year)

(Purchaser(s)’/Transferee(s)’ Signature(s)

_______________________________________

___________________________________________

(Notary Public’s Signature & Notary Seal or Stamp)

(Purchaser(s)’/Transferee(s)’ Telephone # Including Area Code)

_______________________________________

(Date Notary Commission Expires)

Note: This properly completed and signed form must accompany the new vehicle

owner’s title and license plate application.

Print this form!

Clear form

Form T-214 - Purchaser'S Statement Of Fact

Related Articles

Related forms

Related Categories