Form 105a - Affidavit Of Delivery printable pdf download

Form 105a - Affidavit Of Delivery

Affidavit of Delivery

STATE OF WYOMING

COUNTY Of

(List County if delivered in Wyoming) (Date of Delivery

)

I, of ,

(Seller's Name) (Name of Business/Dealership) (Title)

being first duly sworn on oath do hereby declare that delivery of the following described tangible

personal property:

(Detailed description of item)

was made to:

(VIN or Serial Number, if applicable) (Purchaser's Name)

on at:

(Delivery Date)

(City, Street, County, State of Delivery)

(Seller's Signature)

I, being first duly sworn on oath do hereby declare that I took delivery

(Purchaser's Name)

of the above referenced tangible personal property at the delivery address listed above.

(Purchaser's Signature)

STATE OF WYOMING

COUNTY OF

The foregoing instrument was acknowledged before me by

(Seller's Name)

and by

(Purchaser's Name)

this day of , 20 .

My commission expires:

(Notary Public)

Turn Form Over For Instructions

ETS Form 105a (Revised 09/26/08)

Form 105a - Affidavit Of Delivery