Fill and Sign the Affidavitloss of Certificate of Title to Vehicle Form

Affidavit Regarding Loss of Certificate of Title (or Ownership Certificate) to Vehicle State of _______________________________County of _________________________Affiant, _________________________________________ (name of affiant) , being duly sworn, deposes and says:1. An ownership certificate (or certificate of title) was issued to Affiant on _________________________________ (date of issue), for the following motor vehicle:A. Type of vehicle : _____________________________________ (e.g., automobile, trailer or motorcycle) . B. Make: _____________________________________________ (e.g., Chevrolet).C. Model and year: _____________________________________ (e.g., 2006 Aveo).D.Date sold to Affiant: _______________________________ (Date of sale).F.Number of cylinders: _________________ (e.g., six).G.Vehicle Identification Number: ________________________________________ 2.The ownership certificate (or certificate of title) referred to above was lost by Affiant on or about _______________________________________ (date of loss), and Affiant now applies for issuance of a duplicate certificate.3. Affiant resides at _________________________________________________________ ____________________________________________________________________________ (street address, city, county, state, zip code), and is the registered owner of the above-described vehicle.4. The facts stated above are known by me to be true, and of my own personal knowledge. ____________________________ (Name of Affiant) SWORN to and subscribed before me, this the day of _______________________, 20_____. ________________________________ Notary Public My Commission Expires: ____________________