Form 46633 - Affidavit - Dealer
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SECRETARY OF STATE - DEALER DIVISION
AFFIDAVIT - DEALER
302 W. Washington Street, Room E018
Indianapolis, Indiana 46204-2700
State Form 46633 (R3 / 8-09)
Telephone: (317) 234-7190
Fax: (317) 233-1915
Dealer: A copy of this affidavit must be kept on file for inspection a minimum of three (3) years from the date of purchase.
STATE OF __________________________________
SS:
COUNTY OF ________________________________
I affirm, under the penalties for perjury, that all of the following are true:
(1)
That I am a dealer licensed under IC 9-23-2-1.
(2)
That I cannot deliver a valid certificate of title to the retail purchaser of the vehicle described in paragraph (3) at the time
of sale of the vehicle to the retail purchaser. The identity of the previous seller or transferor is
_________________________________________________.
Payoff of lien was made on ________________________. I expect to deliver a valid and transferable certificate of title
(month, day, year)
not later than ________________________ from the State of ________________________________ to the purchaser.
(month, day, year)
(3)
That I will undertake reasonable commercial efforts to produce the valid certificate of title. The vehicle identification
number is _________________________________________.
Name of dealership
By:
Date (month, day, year)
Customer acknowledges receipt of a copy of this affidavit.
Signature of customer
Date (month, day, year)
NOTICE TO THE CUSTOMER
If you do not receive a valid certificate of title within the time specified by this affidavit, you have the right to return the vehicle to the vehicle
dealer ten (10) days after giving the vehicle dealer written notice demanding delivery of a valid certificate of title within that ten (10) day period.
Upon return of the vehicle to the vehicle dealer in the same or similar condition as when it was delivered to you, the vehicle dealer shall pay
you the purchase price plus sales taxes, finance expenses, insurance expenses, and any other amount that you paid to the vehicle dealer.
If a lien is present on the previous owner’s certificate of title, it is the responsibility of the third party lienholder to timely deliver the certificate
of title in the third party’s possession to the dealer not more than ten (10) business days after there is no obligation secured by the vehicle.
If the dealer’s inability to deliver a valid certificate of title to you within the above-described ten (10) day period results from the acts or omissions
of a third party who has failed to timely deliver the certificate of title in the third party’s possession to the dealer, the dealer may be entitled to
claim against the third party the damages allowed by law.
DISTRIBUTION:
Original - Dealer jacket; Photocopy - Customer
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