Form T-107a - Odometer Discrepancy Affidavit - Purchaser'S Statement Of Facts

Download a blank fillable Form T-107a - Odometer Discrepancy Affidavit - Purchaser'S Statement Of Facts in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form T-107a - Odometer Discrepancy Affidavit - Purchaser'S Statement Of Facts with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

T-107A (Revised 08-2005)
Odometer Discrepancy
Affidavit
Purchaser’s Statement of Facts:
This is to certify that on ___________, I_______________________________________
(Date)
(Purchaser’s Full Legal Name)
________________________________________________________________________
(Purchaser’s Address Including City, State & Zip)
acquired the following vehicle:
__________________________________
__________________________________
(Year & Make Vehicle)
(Vehicle Identification Number)
From:
________________________________________________________________________
(Seller’s Full Legal Name & Address)
This is to also certify that at the time that I acquired this vehicle, the odometer reading on
this vehicle was: _______________________________ and to the best of my knowledge
(Odometer Reading –No Tenths)
reflected the correct odometer reading.
In error, the documents pertaining to the
application for title to this vehicle reflected an incorrect odometer reading due to the
following reason:
________________________________________________________________________
________________________________________________________________________
This is to further certify that I am aware of the facts contained in the above Purchaser’s
Statement of Facts. I further agree to indemnify the Georgia Department of Revenue for
any and all losses, which it might suffer due to the existence of facts to the contrary of
those contained in this affidavit:
_________________________________
_________________________________
(Date)
(Purchaser’s Signature)
Sworn to and subscribed before me this
_________________________________
(Purchaser’s Signature)
________ of ______________, _______
(Day)
(Month)
(Year)
_______________________________________
(Telephone Number Including Area Code)
________________________________
_
(Signature of Notary Public/Justice of Peace)
_______________________________________
(Date Notary Commission Expires)
Important Notice: Affidavits must be obtained from all owners involved since the
discrepancy in the odometer reading occurred. Persons appointed by a power of attorney
cannot complete this affidavit.
Print this form!
Clear form

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form T-107 - Odometer Discrepancy Affidavit - Seller(s)'/transferor(s)' Statement Of Facts Form T-107 - Odometer Discrepancy Affidavit - Seller(s)'/transferor(s)' Statement Of Facts Financial
Form T-214 - Purchaser's Statement Of Fact Form T-214 - Purchaser's Statement Of Fact Financial
Form Sar 22 - Sponsor's Statement Of Facts Income And Resources - California Health And Human Services Agency Form Sar 22 - Sponsor's Statement Of Facts Income And Resources - California Health And Human Services Agency Legal
Form Qr 22 - Sponsor's Statement Of Facts Income And Resources Form Qr 22 - Sponsor's Statement Of Facts Income And Resources Legal
Form Soc 860 - Sponsor's Statement Of Facts Income And Resources Form Soc 860 - Sponsor's Statement Of Facts Income And Resources Legal
Purchaser's Statement Of Tax Exemption Purchaser's Statement Of Tax Exemption Legal
Form T-207a - Foreign Document Affidavit Owner's Declaration Form T-207a - Foreign Document Affidavit Owner's Declaration Financial
Form Nj-1065 E-2016 - Nonresidentcorporate Partners's Statement Of Being An Exempt Corporation Or Maintaining A Regular Place Of Business Form Nj-1065 E-2016 - Nonresidentcorporate Partners's Statement Of Being An Exempt Corporation Or Maintaining A Regular Place Of Business Financial
Form 1120-ic-disc - Schedule K - Shareholder's Statement Of Ic-disc Distributions - 2006 Form 1120-ic-disc - Schedule K - Shareholder's Statement Of Ic-disc Distributions - 2006 Financial
Form Sc2 - Statutory Sick Pay (ssp) Employee's Statement Of Sickness Form Sc2 - Statutory Sick Pay (ssp) Employee's Statement Of Sickness Financial

Related Categories

Parent category: Financial
Download
Go