Form 12787 - Statement Of Existing Lease Agreement - 1996
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1STATEMENT OF EXISTING LEASE AGREEMENT
State Form 12787 (R / 3-96)
The following statement must be properly signed by both Lessor and Lessee, and presented to the Bureau of Motor Vehicles f
all leased motor vehicles.
We ___________________________________________ Address _________________________________________________________________
are the owners of:
Year ____________ Make _____________ Identification # ____________________________________________________
and have entered into a lease agreement with the following lessee:
Address
Lessee
County
THE PLATE FEE AND COUNTY EXCISE TAX ARE TO PAID BY THE: (Check one)
LESSEE
LESSOR, and will remain the propert
( If plate / excise ownership is different than indicated, an attached affidavit stating ownership is required.)
THIS AFFIDAVIT HAS BEEN REVIEWED, AND IS BEING SIGNED UNDER PENALTY OF PERJURY .
Signature of Owner / Lessor
Date (month, day, year)
By ( N ame)
Position
Signature of Lessee
Date ( month, day, year)
STATEMENT OF EXISTING LEASE AGREEMENT
State Form 12787 (R / 3-96)
The following statement must be properly signed by both Lessor and Lessee, and presented to the Bureau of Motor Vehicles f
all leased motor vehicles.
We ___________________________________________ Address _________________________________________________________________
are the owners of:
Year ____________ Make _____________ Identification # ____________________________________________________
and have entered into a lease agreement with the following lessee:
Address
Lessee
County
THE PLATE FEE AND COUNTY EXCISE TAX ARE TO PAID BY THE: (Check one)
LESSEE
LESSOR, and will remain the propert
( If plate / excise ownership is different than indicated, an attached affidavit stating ownership is required.)
THIS AFFIDAVIT HAS BEEN REVIEWED, AND IS BEING SIGNED UNDER PENALTY OF PERJURY .
Signature of Owner / Lessor
Date (month, day, year)
By ( N ame)
Position
Signature of Lessee
Date ( month, day, year)
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