New Jersey Motor Vehicle Commission STATE OF NEW JERSEY 1-609-292-6500 ext. 5070 P.O. Box 017 Trenton, NJ 08666-0017 Notice of Seizure of Motor Vehicle To be filed immediately with central office of the New Jersey Motor Vehicle Commission (address listed below) by the person or officer effecting the seizure of the vehicle N.J.S.A. 39:10-15 as amended, I hereby file notice with you that I -Levied upon or -Seized and took possession of motor vehicle herein described on ______________, by virtue of ____________________________from the following: Date Description of Owner/Lienholder Name of Titled Owner Driver License No./Corpcode Street Address Name of Lienholder Street Address City State Zip City State Zip Description of Motor Vehicle Complete Vehicle Identification No. Make Model Vehicle Type License Plate No. Year Odometer Reading (no tenths) Motor Vehicle Present Location Street Address City State Are you in physical possession of the vehicle: -Yes or -No NCIC: -Yes or -No Writ Of Execution County of Writ & Docket Number Lawyer/Firm's Name & Address Lawyer/Firm's Phone Number Plaintiff' Information I the undersigned do hereby certify that the information contained in this notice is correct in every detail. If the sale is not held, I agree to return the execution or foreclosure application form immediately, if issued, to the New Jersey Motor Vehicle Commission for cancellation. __________________________ Date Notice of Seizure was filed __________________________________________________________ Name Title and Phone Number of Person making seizure __________________________________________________________ Address City State Zipcode __________________________________________________________ Signature of person making seizure OS/SS-55 (R3/14) Mail notice/documents to: NJ Motor Vehicle Commission Special Title/Repossession Unit 225 E. State Street P.O. Box 017 Trenton, New Jersey 08666-0017 American LegalNet, Inc. www.FormsWorkFlow.com