Form 46633 - Affidavit
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1AFFIDAVIT (Dealer)
Dealer: A copy of this affidavit must be kept on file
for inspection a minimum of three (3) years from the
State Form 46633 (5-94)
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 on ___________________________ a valid Certificate of Title to the retail purchaser of the vehicle
Date of sale
described in paragraph 3. The identity of the previous seller or transferor is ____________________________. I expect
Name of seller / transferor
to deliver a valid and transferable Certificate of Title on or about ____________________, _______________________,
Day
Date (mo., day, yr.)
from the State of ______________________________________ to the purchaser.
3. That I will undertake reasonable commercial efforts to produce the valid Certificate of Title. The vehicle identification
number is ___________________________________.
Signed (dealer)
By
Date signed (mo., day, yr.)
Customer acknowledges receipt of a copy of this affidavit.
Signature of customer
Date signed (mo., day, yr.)
DISTRIBUTION:
White - Dealer;
Canary - Customer
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Parent category: Legal