Form Tc-569 - Combined Affidavit (Page 2 of 2) in pdf

Repossession and Bill of Sale

Repossessed from

Name of person or company from which the vehicle was repossessed

Address (include street, city, state, and ZIP code)

Repossessed by (lien holder)

Name of agent who repossessed vehicle

Date repossessed

Name of company repossessing vehicle

Address (include street, city, state, and ZIP code)

Name of person or company to whom vehicle is legally transferred

Selling price

Date of transfer

Under penalties of perjury, I declare that I, acted as an agent for the company who is the Utah certificate of title lien holder of the vehicle shown on

this affidavit, and I did lawfully repossess the said vehicle under default, based on the conditions of the original instrument. I further certify that said

vehicle was repossessed from the person or company named on this affidavit and that I delivered and conveyed all rights, title, and interest to the

transferee named hereon.

Place notary stamp in this space

I further certify, to the best of my knowledge, the odometer statement shown on this affidavit is true.

I further state that the repossessing company agrees to indemnify the Utah State Tax Commission, and all

persons acting under their direction, from any and all liability and shall defend all litigation that may arise as

a result of the issuance of a new Certificate of Title on the vehicle described above.

Notary signature

Date

Signature of agent/repossessor

Motor Vehicle Survivorship

Name of the deceased

City and state where deceased died

Date of death

Transferee (name of person to whom the title is being transferred)

Pursuant to Utah Code, I hereby transfer the Certificate of Title and the last registration issued for the vehicle identified on this affidavit to the

transferee shown above.

I certify that the decedent left not more than four boats, motor vehicles, trailers, or semi-trailers, and that 30 days have elapsed since the death of the

decedent. No appointment of a personal representative has been granted or is pending. The value of the entire estate subject to administration, where ever

located, excluding the boats, motor vehicles, trailers, or semi-trailers, less liens and encumbrances, does not exceed $25,000. I further certify that the

claimant is entitled to the vehicle and that the creditors of the decedent will not be prejudiced by this transfer.

Place notary stamp in this space

It is expressly understood that in the event any debt of the decedent, that would have been collected in probate

proceedings from the decedent's estate, is not satisfied at the time of this transfer, the affiant shall be personally

liable to the extent of the fair market value of the said vehicle at the time of the death of said decedent.

I further certify that, to the best of my knowledge, the odometer statements shown on this affidavit are true.

Notary signature

Signature of affiant (survivor)

Date

Name Change Affidavit

STATE OF

)

: SS

COUNTY OF

)

The undersigned hereby swears and deposes that up until the __________ day of _____________________________, 19_____, his/her legal

name was _____________________________________________________. That on the __________ day of ______________________ , 19 _____,

(

old name)

his/her name was changed by law to __________________________________________________________.

Place notary stamp in this space

(

new name)

That affiant and _____________________________________________________ are one and the same person.

(

old name)

Signature using

new

name

Notary signature

Date

Visit the Tax Commission's World WIde Home Page at

If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811 or Telecommunications Device

for the Deaf (801) 297-3819. Please allowing three working days for a response.

The purchaser must submit the required documentation stated above to the local motor vehicle office to complete the plate and title registration.

Contact the Division of Motor Vehicles, 297-7780 or 1-800-368-8824 for the address of the office near you.

Form Tc-569 - Combined Affidavit Page 2

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