Affidavit Of Disposition Of Abandoned Motor Vehicle Form

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IN THE MAGISTRATE COURT OF WALTON COUNTY, STATE OF GEORGIA
Civil Action#: ______________________________
_____________________________________________
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AFFIDAVIT OF DISPOSITION OF
Plaintiff/Lien Claimant
Vs.
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ABANDONED MOTOR VEHICLE
*
_____________________________________________
*
*
Motor Vehicle (list year, make, model)
_____________________________________________
Vehicle Identification Number (VIN#)
_____________________________________________
Tag number (list State, if applicable)
The name(s) and addresses(s) of the last known registered owner(s) &/or lienholder(s): (“Owner” means registered owner, the owner as recorded on
title, lessor, lessee, security interest holder(s) & all lienholders as shown on the records of the Department of Motor Vehicle Safety);
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
I, ___________________________________________________________, (hereinafter referred to as Plaintiff), personally appeared before the
undersigned officer, duly authorized to administer oaths, swears/affirms the following;
The vehicle was redeemed by owner/lienholder prior to public auction. No sums are due and payable.
OR;
The vehicle was sold at public auction: On ____________________.
Date of Sale
_____________________________________________________________________________________________
Address of sale (street, city, state, zip code)
Within the city limits of: ___________________________________________________.
Unincorporated Walton
County.
The sale was conducted in compliance wit the provisions of O.C.G.A. 40-11-6.
The vehicle was impounded at the request of a:
1.
private individual
city officer/official of ________________________________________________ (Name of Municipality)
county officer/official
Georgia State Patrol.
2.
The amount received for the vehicle at public sale:
$ _____________________________
3.
The amount of the lien on the vehicle
$ _____________________________
4.
Future storage at $ ______________ per _____________ (days) $ _____________________________
5.
The amount due to Clerk of Court and submitted herewith
$ _____________________________
A true and correct copy of the bill of sale of the vehicle is attached hereto as Exhibit A.
_______________________________________________________________
Plaintiff or Agent for Plaintiff
Sworn to and subscribed before me this
_______day of ________________________________, 20_______.
_____________________________________________________
Notary Public/Attesting Official

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