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MV-603I (Rev. 06-2005)
Abandoned Vehicle Affidavit
From Insurance Company or Company Storing Vehicle For Insurance Company
State of Georgia, County of ____________________
I, ____________________________________________________________________, a duly authorized agent of
Owner/Agent of Company Storing Vehicle
_______________________________________ do hereby solemnly swear or affirm that the vehicle described as:
Company Storing Vehicle
Year Model & Make of Vehicle
Vehicle Identification Number
was removed to and/or has been stored at:_________________________________________________________.
Location Where Stored
Said vehicle is now an abandoned vehicle as defined in OCGA §40-11-1 (1) and has not been claimed by the
owner, lessor, lessee or any holder of a lien or security interest.
I further solemnly swear or affirm that in following the procedure to foreclose on an abandoned vehicle lien on
said vehicle, I have complied with the requirements of OCGA §40-11-2 as evidenced by the following:
This vehicle was being stored by an insurance company providing insurance to cover damages to the vehicle
as provided in OCGA §40-11-2 (e), but has become abandoned. The name and address of said insurer is:
(Name & Address of Insurer)
did not acquire said vehicle after paying a total loss claim. Please check one box.
Within seven (7) calendar days of the day such vehicle became an abandoned motor vehicle, I/we gave notice
in writing to the Department of Revenue pursuant to the procedure set forth in OCGA §40-11-2 (e) and
requested the name and address of all owners of such vehicle as evidenced by the document(s) attached
hereto and incorporated herein as “Exhibit A”.
Within five (5) calendar days of having received the information requested, I/we either:
Notified the owner, or lessee, or any holder of a lien or security interest by certified mail and first
class mail; and,
b. Placed an advertisement in a newspaper of general circulation in the county where such vehicle
was obtained once a week for two (2) consecutive weeks because the owner could not be
ascertained or the certified mail was returned undeliverable; or,
Placed an advertisement at the county courthouse in such place where other public notices are
posted for two (2) consecutive weeks because there is no newspaper in such county.
Pursuant to OCGA §40-11-2 (f), said notice advised the owner(s) of their obligations and rights to
redeem such vehicle and such owner, lessee or holder of a lien or security interest has either disclaimed
their ownership or interest in such vehicle, as evidenced by the document(s) attached hereto and
incorporated herein by reference or has failed to redeem such vehicle.
I/We have made demand for payment of $____________, which demand has not been satisfied. More
than ten-days (10) have elapsed since notification and no petition for a judicial hearing has been made.
Therefore, I/we ask the court to authorize the foreclosure of my/our lien and the sale of this motor vehicle.
Signature of Owner or Agent of Company Storing Vehicle
Sworn and subscribed before me
Street Address for Company Storing Vehicle
City, State & Zip
Notary Public’s Signature & Notary Seal or Stamp
Telephone Number Including Area Code
Date My Notary Commission Expires