Form T-216 - Affidavit Of Georgia Certificate Of Title Lost In The Mail
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1T-216 (Rev 2-23-2011)
Affidavit of Georgia Certificate of Title
Lost in the Mail
Section 40-3-31, paragraph (5), of Georgia Law, allows for a replacement title to be issued without the $8.00
processing fee when the original certificate of title was lost in the mail prior to its receipt by the vehicle
owner. This provision only applies to those replacement applications received within sixty (60) days of the
title’s issue date. The completed and signed application for a replacement title must be submitted to your
County Tag Agent or to the State Processing Center-Motor Vehicle at the following address: Dept. of
Revenue, Processing Center-Motor Vehicle, P.O. Box 740381, Atlanta, GA 30374-0381, together with this
completed affidavit.
This is to certify that an inquiry was made with State Processing Center-Motor Vehicle or the County Tag
Office and their records reflect that Georgia certificated of title number:
was issued for the following described vehicle:
(Vehicle Year Model, Make & Vehicle Identification Number (VIN))
:
In the names of
(Owner(s)’ Name(s) as Shown on the State Processing Center-Motor Vehicle Record)
Owner’s Address as Shown on the State Processing Center-Motor Vehicle Records:
And was mailed on the following date (month, day & year):
I/We, _________________________________________________________________________
(Owner(s)’ Printed Name(s))
Am/are requesting that a replacement certificate of title be issued for the vehicle described above since this
certificate of title has not been received.
Under the provisions of §40-3-31, paragraph (5), of Georgia Law, I/we do solemnly swear under penalty of a
felony for making a material false statement punishable by a fine up to $5,000.00 or by imprisonment of up
to five (5) years or both that the statements contained herein are true and accurate:
Date:
Owner(s)’ Signature(s):
Owner(s)’ Printed Name(s):
Sworn to and subscribed before me this ____ of
(Day)
________________ ____________
(Month)
(Year)
Notary Public’s Signature & Notary Seal or Stamp:
Owner’s Current Street Address:
Notary Public’s Printed Name:
Owner’s Current City, State & Zip:
Date My Notary Commission Expires:
Except for the signatures, this form must be typed, electronically completed and printed or printed legibly by
hand in blue or black ink and signed. All applicable spaces on this form must be completed. Any
alterations or corrections void this form. The vehicle owner(s) must complete this form. An attorney-in-fact
cannot complete this form. A completed and signed PC-MV tag and/or title application (Form MV-1) must
accompany this form. Applications for replacement title not received more than sixty (60) days from the
title’s issues date cannot be processed without the $8.00 processing fee. A $10.00 special handling fee is
due for those applications processed through the Processing Center-Motor Vehicle’s walk-in or mail-in
expedited service.
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