AFFIDAVIT OF REPOSSESSION
State of Wyoming
County of Fremont
I, ______________________________, first having been sworn according to law, on oath, voluntarily
under the penalty of perjury, deposes and says that on _____ day of _________________, 20_____,
(debtor) ____________________________________________________ executed and delivered to
(creditor)__________________________________________ a lien statement covering the following
described titled property (vehicle, watercraft or mobile home):
Year__________ Make of Titled Property _____________________________________________
Vehicle (VIN) / Hull (HIN) Identification Number:__________________________________________
and said agreement was filed in the office of the County Clerk and ex-officio register of deeds of
Fremont County, Wyoming on __________ day of _________________, 20_____, as instrument
number ______________________ and Wyoming title number _____________________.
That because of default and pursuant to the terms of said lien statement,
(creditor)___________________________________did on _____ day of _____________, 20_____,
take actual possession of said titled property.
Affiant swears that he is making this statement for the purpose of having the County Clerk issue a title
in the following name(s) and address:___________________________________________________
the actual mileage of the vehicle;
and the current odometer reads _________________and is
the amount of mileage in excess of mechanical limits; or
the odometer reading is NOT the actual mileage.
Affiant swears that he or she will warrant and defend the title and rights of this titled property and
protect the County Clerk of Fremont County, Wyoming from any damages that might arise from
irregularities of same.
Signature of Creditor
Subscribed and sworn before me this ______ day of ____________, 20_____. Witness my hand and
County Clerk or Notary Public
My commission expires:__________________