Form Rv-1 - Boat Dealer Registration Instructions Page 18

MV-950 (1/11)

New York State Department of Motor Vehicles

PAGE 1 OF 2

AFFIRMATION OF REPOSSESSION AND BILL OF SALE

INSTRUCTIONS Ø Lenders must complete boxes

2 3 4

5 6

If Lender is selling vehicle, Purchaser information is required in boxes

VEHICLE DESCRIPTION

(includes motor vehicle or motorcycle, manufactured home* or boat * )

YEAR

MAKE

MODEL

STATE LAST REG

STATE LAST TITLED

PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

LENDER

BORROWER

Business

Last Name,

Name

First, M.I.

Number and

Apt. No.

Number and

Apt. No.

Street Address

City

State

ZIP Code

City

State

ZIP Code

The vehicle described above was repossessed in _______________________ on ______________ from the borrower who was in default

(State)

of a security contract dated _______________ . On ________________ , ______________________________________________ was

(Auctioneer)

(Month/Day/Year)

authorized to sell the above vehicle (if applicable).

Section 425(1) of the Vehicle and Traffic Law requires that, when a motor vehicle or motorcycle is repossessed, proper notification must

be provided to the parties listed below, within 24 hours.

(*NOTE: This notification is not required when a manufactured home or boat is repossessed.)

PROPER NOTICE HAS BEEN GIVEN TO THE FOLLOWING PARTIES (list names and addresses ):

Date Notified

Police Agency Name

Address

Commissioner of Motor Vehicles (enter Name

Address

of Motor Vehicles office notified)

Borrower/Current Owner Name

Address

(other than lienholder)

Other Name

Address

Under the penalties of perjury, I affirm that I have complied with Section 425(1) of the New York State Vehicle and Traffic Law (see page 2) and/or any

applicable laws in the state where the vehicle was repossessed, pertaining to the repossession of the vehicle described above. I further affirm that, if there are

any other open perfected liens on the vehicle, and a lien release is not obtained, I have advised the purchaser of the outstanding liens



on the vehicle.

(Lender’s Signature)

ODOMETER DISCLOSURE STATEMENT



, not including tenths.

The odometer on the vehicle described above has (check the appropriate box):

5 digits

6 digits

7 digits

Federal and state laws require that the mileage of the vehicle described above be specified upon transfer of ownership. Failure to do so, or

not telling the truth about mileage, may result in fines and/or imprisonment.

I, _______________________________________________________ state that the odometer now reads ______________________ miles

Lender – Print Name in Full

(do not include tenths of a mile)

and (one of the following statements must be checked):



I certify that, to the best of my knowledge, this odometer reading reflects the “ACTUAL MILEAGE” as seen on the odometer of

the vehicle described above.



I certify that, to the best of my knowledge, the above-disclosed odometer reading “EXCEEDS MECHANICAL LIMITS”. (The mileage

is in excess of what the odometer is capable of recording.)



I certify that, to the best of my knowledge, the above-disclosed odometer reading is “NOT THE ACTUAL MILEAGE. WARNING:

ODOMETER DISCREPANCY.”

DAMAGE DISCLOSURE STATEMENT

Making a false statement, or failure to accurately disclose the salvage status of a vehicle, may subject

IMPORTANT:

you to substantial civil fines, in addition to any penalties authorized by the Penal Law.



I certify that, to the best of my knowledge, this vehicle

wrecked, destroyed or damaged to such

Check one box–

has been

has not been

an extent that the total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and

for legal operation on the road or highways, is more than 75% of the retail value of the vehicle at the time of loss. (Checking the “has been” box means

the vehicle must have an anti-theft examination before being registered, and that the title issued will have the statement “Rebuilt Salvage: NY” on it.)



Lender Signature

Purchaser Signature

PURCHASER:

Print Last Name,

Price

Date of Sale

First, M.I.

Paid

Number and

Apt. No.

City