Form 39738 - Certificate Of Repossession - Bureau Of Motor Vehicles, State Of Indiana

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State of Indiana
Bureau of Motor Vehicles
CERTIFICATE OF REPOSSESSION
State Form 39738 (R/10-95)
NOTE: It is imperative that all questions on this form be answered.
The undersigned, being duly sworn upon his oath, deposes and says that he has repossessed the following described vehicle:
Make
Year
Style or body
Vehicle Identification Number (VIN)
by due process of law because of the failure of the owner, whose name is ____________________________________________, and whose
address is ________________________________________________________________________________________________________
to meet his obligation of settlement of the following terms of incumbrances on said vehicle.
Terms (Condition sale, lease note, Mortgage, etc.)
Amount of original indebtedness
Date of lien (month, day, year)
$
In whose favor or to whom is lien due?
Title number
Address (number and street, city, state, ZIP code)
Was said vehicle new or used when purchased?
New
Used
In what state and under what license number did the person
from whom the vehicle was repossessed register this vehicle?
On what date was the vehicle
Number of license plates attached
Do you have the license plates in your possession
repossessed?
to car at the time of repossession.
at this time?
Yes
No
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 signed (month, day, year)
OVER

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