Free 23037.FH11 - Indiana


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State: Indiana
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AFFIDAVIT OF OWNERSHIP FOR MOTOR VEHICLE
State Form 23037 (R5 / 11-08) / Form AO-1

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A vehicle owner may use the Affidavit of Ownership to obtain title for a vehicle valued at $5,000 or less (140 IAC 6-1-2(e)). I, _______________________________________, __________________________________________________________________,
(Name) (number and street, city, state, and ZIP code)

do hereby swear or affirm that I acquired possession of a ____________, __________________, ______________________________.
(Year) (Make) (Vehicle Identification Number)

As proof of ownership I have submitted for documentation: Vehicle Identification Number (VIN) inspection A letter requesting the registered owner / seller to provide the signed title to the purchaser. The letter must have been sent to the seller by registered mail at the sellers last known address and returned to the sender unopened and marked as being unclaimed. Notarized bill of sale indicating year, make, VIN, seller, purchaser, and selling price. If the notarized bill of sale is from another state, that states department of motor vehicles must provide official verification of status. Information about the seller: ________________________________________________, _______________________________,
(Name) (Cost of vehicle)

_______________________________________________________________________________
(number and street, city, state, and ZIP code)

A lien release, if there are any liens on the vehicle.

Please attest to the appropriate statement by selecting one of the two following statements: I hereby swear or affirm that there are no liens owed on the vehicle. I hereby swear or affirm that there is a lien in the name of: ________________________________________________________.
(Name of lien holder)

I make this affidavit to establish my legal ownership of the above described vehicle and to induce the State of Indiana, Bureau of Motor Vehicles to issue me an Indiana Certificate of Title covering this vehicle. I warrant and agree to defend this claim and to indemnify and hold harmless the Indiana Bureau of Motor Vehicles from any liability arising from this transaction. I swear or affirm that the information that I have entered on this form is correct. I understand that making a false statement on this form may constitute the crime of perjury.
Signature Date (month, day, year)