Lienholder'S Affdavit For Repossession Form
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1
2DMV-129-TR
REVISED 08/2014
West Virginia Department of Transportation
Division of Motor Vehicles
1-800-642-9066
Lienholder’s A davit for Repossession
YOU MUST COMPLETE THIS ENTIRE FORM, FOLLOW ALL INSTRUCTIONS ON THE REVERSE SIDE,
AND ENCLOSE ANY APPLICABLE FEES.
This a davit is for use by the lienholder of a repossessed vehicle to: 1.) secure a repossessed vehicle Certi cate of Title, issued
in the name of the lienholder, if the vehicle is sold under the terms of a conditional sales contract; or 2.) secure a repossessed
vehicle Certi cate of Title in the name of the purchaser if the vehicle is sold at public or private auction under the terms of a
deed of trust, chattel mortgage, or security agreement.
Description of Repossessed Vehicle/Trailer/Boat
MODEL YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER / SERIAL NUMBER / HULL NUMBER
STATE
TITLE NUMBER
Name of Defaulting Owner(s):
Address of Defaulting Owner(s):
Description of Lien Covering the Repossessed Vehicle/Trailer/Boat
/
/
,
.
Amount
Date of
Kind of
C/S/C
D/T
S/A
of Lien:
Lien:
Lien:
Lien in Favor Of:
Address of Lienholder:
,
.
Purchase Price
Purchaser’s Name at Sale:
of Vehicle at Sale:
Address of Purchaser:
The repossessing lienholder, represented by the named o cial below, hereby certi es that the vehicle, trailer, or boat described herein
has been repossessed due to failure of the registered owner to meet their obligation in the settlement of the lien described on this
a davit. The lien contract covering this vehicle, trailer, or boat was executed in accordance with the applicable laws and provisions of
the state in which the lien was originated. The lienholder named herein further certi es that the ‘default terms’ of the lien contract have
been fully complied with regarding giving due notice and authority to dispose of the vehicle, trailer, or boat at public or private sale and
that there are no liens which are superior to the lien stated in this a davit. Additionally, there are no legal suits currently pending in any
court concerning this repossession and the repossessing lienholder warrants the Certi cate of Title for the described vehicle, trailer, or
boat is free from all indebtedness and agree to defend it against any claims.
Printed Name of Repossessing Lienholder:
Printed Name of Authorized O cial:
(X)
Authorized O cial’s Signature
Date
Notary Public Certi cation
N OTA R Y P U BL I C / O F F I C I A L S T A M P
State of: _________ County of: _______________________________
Subscribed and sworn before me this _____________________ day of
___________________________________________, 20___________.
(X)
_______________________________________________________________________________
NOTARY PUBLIC / AUTHORIZED OFFICIAL SIGNATURE
My Commission expires on
____________/_____________/_________________.
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