Free Repossession application - Wisconsin


File Size: 41.8 kB
Pages: 2
Date: January 18, 2008
File Format: PDF
State: Wisconsin
Category: Government
Author: WisDOT
Word Count: 641 Words, 4,046 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.dot.wisconsin.gov/drivers/forms/mv2117.pdf

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REPOSSESSION APPLICATION
MV2117 1/2008 s.409.105(H) Wis. Stats.

Clear form

Title No. - New License Plate No.

Amount Received, Document Number Check Cash

SUBMIT TO: Fee $69.50
Wisconsin Department of Transportation P.O. Box 7949, Madison, WI 53707-7949

A

Instructions:

The Secured Party name and address listed on this form must match DMV records.
Make Vehicle Year Body Style

Vehicle Identification Number

SECURED PARTY - Secured Party Number, Name, and Address - Please Print

REPOSSESSED FROM - Name and Address - Please Print

Social Security # or Driver License # or (if company owned) FEIN # Area Code - Telephone # between 7:30 a.m. and 5 p.m.

Special Mailing -Name and Address - Please Print

Date Repossessed

Security Agreement Date

Repossessed in State OF:

Notice of Sale given to subordinate lienholders

I (we) certify that the above described vehicle was repossessed in the state of and under security agreement as indicated above in compliance with the provisions of the Wisconsin Uniform Commercial Code, s.342.18(2) and 342.19(5), Wisconsin Statutes, and the Wisconsin Consumer Act as amended when applicable. (See s.425.201 through 425.210). I (we) further certify that this vehicle has been sold in compliance with said security agreement, the Wisconsin Uniform Commercial Code and the Wisconsin Consumer Act when applicable to:
BUYER - Name and Address - Please Print

If buyer/dealer at sale is other than repossessor, the buyer/ dealer must complete and submit form MV1, Application for Title/Registration, with this document.

ODOMETER MILEAGE STATEMENT

Federal and State law require that you state the mileage in connection with the transfer of ownership. Failure to complete a mileage statement or providing a false statement may result in fines and/or imprisonment and may make you liable for damages to your transferee (buyer).

I, the repossessor, certify that to the best of my knowledge the information contained on this document is true and correct and that the ODOMETER NOW READS and to the best of my knowledge is actual mileage of this vehicle unless one of the following (No Tenths): statements is checked.

.

The odometer reading reflects the amount of mileage in excess of its mechanical limits. The odometer reading is NOT the actual mileage - WARNING ODOMETER DISCREPANCY.

NOTE - Please provide the current odometer reading above and indicate, to the best of your knowledge, whether the odometer reading is actual, not actual or exceeds mechanical limits. Repossessor sign below on repossessor signature line. BRAND DISCLOSURE STATEMENT will be printed on future titles. Check all that apply.

Flood Damaged Previous Taxicab

Hail Damaged Previous Police Vehicle

Salvage Vehicle

(Print Name of Buyer Signing Below)

(Print Name of Repossessor Signing Below)

X
(Signature of Buyer) (Date)

X
(Signature of Repossessor or Authorized Agent) (Date)

Complete section "B" on reverse side when vehicle has been repossessed by someone other than secured party shown above.

Complete section "C" on reverse side when vehicle has been repossessed outside Wisconsin.

Print

REPOSSESSOR STATEMENT
pursuant to s.421.201(5) Wis. Stats.

B

Repossessor (If different from that shown in section "A")

Name - Print

Residence - County

State

C

Repossession (If vehicle repossessed outside Wisconsin)
Per Laws of State of

Repossessed in State of

Vehicle Location

Number of Days at Location Indicated

I certify that: 1. 2. As repossessor I was employed by the identified secured party in section "A"; The person identified as "Repossessed From", section "A", who is incorporated by reference, was a resident of Wisconsin at the time of execution of the security agreement and removed the above identified vehicle from Wisconsin for a period in excess of 15 days; The information on this statement is true and correct to the best of my knowledge; This statement is in support of a request for retitling the vehicle identified on reverse side.

3. 4.

X
(Repossessor/Authorized Agent Signature)

Print