Affidavit For Certificate Of Title Correction
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AFFIDAVIT FOR CERTIFICATE OF TITLE CORRECTION
State Form 55582 (R / 10-14)
INDIANA BUREAU OF MOTOR VEHICLES
INSTRUCTIONS:
1. Complete in blue or black ink or print form. Copies may be accepted.
2. Use the form below to correct information on a certificate of title or certificate
of origin that contains errors, erasures or alterations. Illegible titles will not be accepted.
SECTION 1. AFFIRMATION OF SELLER(S)
Seller(s) Name (last, first, middle initial or company name)
Certificate of Title Number (if applicable)
Title Issue Date (mm/dd/yyyy)
VEHICLE IDENTIFICATION NUMBER or HULL IDENTIFICATION NUMBER
Year
Make
Model
The following information was entered in error on the certificate of title or certificate or origin indicated above. I
hereby request the Indiana Bureau of Motor Vehicles to correct this information upon application for certificate of
title by the Purchaser.
The Odometer Reading or Brand is incorrect.
(A separate conforming odometer statement is required to be attached to this form.)
The Date of Sale is incorrect. The correct Date of Sale is: ______________________ (mm/dd/yyyy).
The Selling Price is incorrect.
The Trade in Price is incorrect.
The Total Price Paid is incorrect.
The Selling Price is:
The Trade in Price is:
The Total Price Paid is:
$__________.____
$__________.____
$__________.____
The Name of Purchaser is incorrect and no other purchaser(s) have taken possession of this vehicle/watercraft other
than the purchaser(s) indicated on this form. The Purchaser(s) is: _____________________________________________.
Other: (Explain below.)
I swear or affirm that the information entered on this form is true and correct. I understand that making a false
statement may constitute the crime of perjury. I agree to indemnify and hold harmless the Indiana Bureau of Motor
Vehicles from any liability arising from this transaction.
Seller Signature
Printed Name
Date (mm/dd/yyyy)
Seller Signature
Printed Name
Date (mm/dd/yyyy)
The knowing or intentional failure of the seller or transferor to fill in all buyer information is a Class A misdemeanor or a
Class D felony for the second or subsequent offense under IC 9-17-3-7(c) (2). (A Class A misdemeanor for the first
violation; or a Class D felony for the second violation or any subsequent violation.)
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