Hold Harmless Affidavit Page 2
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1
2HOLD HARMLESS AFFIDAVIT
THE STATE OF TEXAS
KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF DALLAS
WHEREAS, by virtue of a valid and existing mortgage lien contract by and between
_____________________________________________, hereinafter call Mortgagor, and
_____________________________________________, hereinafter called Mortgagee, the said Mortgagee
is the holder of a lien on a certain automobile, Make, Model and Body Style ________________________,
License
Number
__________________,
Vehicle
Identification
Number
___________________________________,
said
lien
appearing
on
Certificate
of
Title
No.
___________________________________, and,
WHEREAS, said Mortgage lien contract provides that in the event the Mortgagor defaults in his payments
to the Mortgagee, the Mortgagee thereby becomes entitled to possession of said automobile; and,
WHEREAS, the said Mortgagor has defaulted in his payments to the said Mortgagee, the Mortgagee is
entitled to possession of said automobile; and,
WHEREAS, the said automobile is in the possession of the Dallas Police Department of the City of Dallas,
Texas, and the Mortgagee desires to have said automobile delivered to him, her, it; and,
WHEREAS, the said Mortgagee is willing to indemnify and save harmless the City of Dallas, its Police
Department and its employees because of delivery of said automobile to him, her, it.
NOW, THEREFORE, in consideration of the delivery to him, her, it of said automobile the said Mortgagee
covenants and promises to and does by these presents indemnify and save harmless the City of Dallas, its
Police Department and its employees by virtue of the said City of Dallas and its Police Department having
delivered to the said Mortgagee the said automobile.
____________________________________
By: ________________________________
State of __________________
County of ________________
BEFORE
ME,
the
undersigned,
a
Notary
Public,
on
this
day
personally
appeared
______________________________________,
authorized
agent
acting
in
behalf
of
_____________________________________, known to me to be the person whose name is subscribed to
the foregoing instrument, and having been duly sworn, upon his oath deposes and says that he has read the
above statements and they are true and correct, and acknowledged to me that he executed the same for the
purposes and consideration therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE, this the __________________ day of
_____________, A.D. 20_________.
___________________________________________
NOTARY PUBLIC’S SIGNATURE
(SEAL)
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