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Repo Order Form 2017
Including City, State & Zip Code
Vehicle Year Model & Make
Vehicle Identification Number (VIN)
Lien or Security Interest Holder’s Name
Current Title #
Date of Repossession
Address
City, State & Zip Code
I, the undersigned, hereby certify that the information shown on this form is complete and
correct. I also certify that all holders of unsatisfied liens and/or security interests recorded
against this vehicle on the records of the Georgia Department of Revenue, Motor Vehicle
Division, have...
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