Free 12787.pdf - Indiana

STATEMENT OF EXISTING LEASE AGREEMENT
State Form 12787 (R / 3-96)

The following statement must be properly signed by both Lessor and Lessee, and presented to the Bureau of Motor Vehicles for title / registration of all leased motor vehicles.

We ___________________________________________ Address _________________________________________________________________ are the owners of: Year ____________ Make _____________ Identification # _______________________________________________________

and have entered into a lease agreement with the following lessee: Lessee County Address

THE PLATE FEE AND COUNTY EXCISE TAX ARE TO PAID BY THE: (Check one) LESSEE LESSOR, and will remain the property of the same. (If plate / excise ownership is different than indicated, an attached affidavit stating ownership is required.) THIS AFFIDAVIT HAS BEEN REVIEWED, AND IS BEING SIGNED UNDER PENALTY OF PERJURY .
Signature of Owner / Lessor Date (month, day, year)

By (Name)

Position

Signature of Lessee

Date (month, day, year)

STATEMENT OF EXISTING LEASE AGREEMENT
State Form 12787 (R / 3-96)

The following statement must be properly signed by both Lessor and Lessee, and presented to the Bureau of Motor Vehicles for title / registration of all leased motor vehicles.

We ___________________________________________ Address _________________________________________________________________ are the owners of: Year ____________ Make _____________ Identification # _______________________________________________________

and have entered into a lease agreement with the following lessee: Lessee County Address

THE PLATE FEE AND COUNTY EXCISE TAX ARE TO PAID BY THE: (Check one) LESSEE LESSOR, and will remain the property of the same. (If plate / excise ownership is different than indicated, an attached affidavit stating ownership is required.) THIS AFFIDAVIT HAS BEEN REVIEWED, AND IS BEING SIGNED UNDER PENALTY OF PERJURY .
Signature of Owner / Lessor Date (month, day, year)

By (Name)

Position

Signature of Lessee

Date (month, day, year)