Free 46633.FH11 - Indiana

AFFIDAVIT - DEALER
State Form 46633 (R2 / 5-08)

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SECRETARY OF STATE - DEALER DIVISION 6400 East 30th Street Indianapolis, Indiana 46219 Telephone: (317) 591-5304

Dealer: A copy of this affidavit must be kept on file for inspection a minimum of three (3) years from the date of purchase.

STATE OF __________________________________ SS: COUNTY OF ________________________________

I affirm, under the penalties for perjury, that all of the following are true:

(1)

That I am a dealer licensed under IC 9-23-2-1.

(2)

That I cannot deliver a valid certificate of title to the retail purchaser of the vehicle described in paragraph (3) at the time of sale of the vehicle to the retail purchaser. The identity of the previous seller or transferor is _________________________________________________. Payoff of lien was made on ________________________. I expect to deliver a valid and transferable certificate of title not later than ________________________ from the State of ________________________________ to the purchaser.
(month, day, year) (month, day, year)

(3)

That I will undertake reasonable commercial efforts to produce the valid certificate of title. The vehicle identification number is _________________________________________.

Name of dealership

By:

Date (month, day, year)

Customer acknowledges receipt of a copy of this affidavit.
Signature of customer Date (month, day, year)

NOTICE TO THE CUSTOMER If you do not receive a valid certificate of title within the time specified by this affidavit, you have the right to return the vehicle to the vehicle dealer ten (10) days after giving the vehicle dealer written notice demanding delivery of a valid certificate of title within that ten (10) day period. Upon return of the vehicle to the vehicle dealer in the same or similar condition as when it was delivered to you, the vehicle dealer shall pay you the purchase price plus sales taxes, finance expenses, insurance expenses, and any other amount that you paid to the vehicle dealer. If a lien is present on the previous owners certificate of title, it is the responsibility of the third party lienholder to timely deliver the certificate of title in the third partys possession to the dealer not more than ten (10) business days after there is no obligation secured by the vehicle. If the dealers inability to deliver a valid certificate of title to you within the above-described ten (10) day period results from the acts or omissions of a third party who has failed to timely deliver the certificate of title in the third partys possession to the dealer, the dealer may be entitled to claim against the third party the damages allowed by law.

DISTRIBUTION:

Original - Dealer jacket; Photocopy - Customer