Voided Assignment Letter
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1V O I D E D A S S I G N M E N T L E T T E R
TO:
N.H. DEPARTMENT OF SAFETY
DATE
DIVISION OF MOTOR VEHICLES
BUREAU OF TITLE & ANTI-THEFT
NAME
23 HAZEN DRIVE, CONCORD, NH 03305
YR./MAKE
V.I.N.
Please find one of the following reasons checked as to why there is a voided assignment or erasure on
the Certificate of Title or Certificate of Origin:
The Name was misspelled.
The wrong name was given or entered in error.
The original deal was cancelled.
The address was incorrect.
The incorrect odometer reading was given, or an odometer disclose block checked in error.
The wrong Lienholder was given.
Lienholder listed in error.
Other: (Explain)
SIGNATURE OF SELLERS(S)
NOTE: Assignment of title, form TDMV 17A shall be completed and submitted with this letter. However,
dealer will use the available assignment spaces on the back of the title or Certificate of Origin.
PENALTY (RSA 262:1I):
A PERSON WHO, WITH FRAUDULENT INTENT, USES A FALSE OR FICTITIOUS NAME OR ADDRESS, OR
MAKES A MATERIAL FALSE STATEMENT, OR FAILS TO DISCLOSE A SECURITY INTEREST, OR
CONCEALS ANY OTHER MATERIAL FACT, IN AN APPLICATION FOR A CERTIFICATE OF TITLE, OR IN
ANY PROOF OR STATEMENT IN WRITING, IN CONNECTION THEREWITH, SHALL BE GUILTY OF A
CLASS B FELONY IF A NATURAL PERSON, OR GUILTY OF A FELONY IF ANY OTHER PERSON.
TDMV 111 (Rev. 04/07)
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