IN THE MAGISTRATE COURT OF _________________________ COUNTY STATE OF GEORGIA Plaintiff vs. (Motor Vehicle) (Vehicle Identification Number) * * * * * * * * * * * Civil Action File No: (Tag Number) AFFIDAVIT FOR FORECLOSURE OF ABANDONED MOTOR VEHICLE The name(s) and address(es) of the last known registered owner(s) and/or all lienholder(s) of the vehicle is/are: [ ] Unknown; Personally appeared before the undersigned officer, duly authorized to administer oaths, , who being duly sworn, deposes and states as follows: 1. The Plaintiff is in possession of the above described motor vehicle. The vehicle was impounded at the request of a: [ ] private individual [ ] city officer/official [ ] county officer/official [ ] Georgia State Patrol. 2. The Plaintiff has taken the following described actions to perfect the lien on the vehicle as set forth below: [ ] Notices have been provided to the last known owner and lienholder as follows: (See O.C.G.A. 40-11-2) Event Deadline Vehicle Towed N/A Owner & Lien info requested from law enforcement 40-11-2(a)(b) Within 72 hours of towing First Notice to Owner & Lienholder By Certified or Registered Mail 40-11-2(d) Within 7 days (or forfeit storage fees) [ ] 7th day ended on Sat., Sun., or legal holiday and notice was given next day DMV Statement Filed Within 7 Days Vehicle Became Abandoned 40-11-2(e) Within 7 days of the 30 day deadline from date vehicle removed Information Received from DMV N/A This notice applies ONLY when owner/lienholder ascertained solely thru DMV: Notice(s) to Owner & Lienholder By Certified orRegistered Mail of vehicle location, is deemed abandoned if not redeemed. 40-11-2(f) Within 5 days of receipt of DMV info, excluding Sat., Sun., & legal holidays. Additional Notice(s) to Owner & Lienholder By Certified or Registered Mail of itemized statement of removal, storage and advertising fees, if applicable. (May be combined with preceding notice if owner info ascertained only from DMV.) 40-11-5(2) Date Completed After the 30 days from the date vehicle removed and before one year from removal date or date lien recorded. AMV Affidavit 01/06/00 American LegalNet, Inc. www.USCourtForms.com [ The above notices were not sent because the identity of the owner and/or lienholder cannot be ascertained. Proper notice has been given by running an advertisement as required by O.C.G.A. § 40-11-2(g). [ 3. ] ] More than ten (10) days prior to filing this Affidavit, demand was made by certified or registered mail upon the last known registered owner of the vehicle for the payment of the reasonable fees for removal and storage plus the costs of any applicable advertisement, including an itemized statement of all charges. The Plaintiff has complied with the notice requirements of O.C.G.A. § 40-11-2 by one or more of the following methods: [ ] [ ] checking the motor vehicle records of another state if the Plaintiff has knowledge of facts which reasonably indicate that the vehicle is registered in another state. [ ] placing an advertisement in a newspaper of general circulation in _____________________ County once a week for two consecutive weeks for vehicles of which the identity of the owner cannot be ascertained. [ 4. seeking the identity of the last known registered owner from a local law enforcement agency and the identity of the last known registered owners, lessors, lessees, security interest holders and lienholders from the Department of Revenue. ] notifying the owner by registered or certified mail of the owner’s right to redeem the vehicle. This affidavit is made within a period of one year from: [ ] the recording of a lien on the vehicle with the Department of Motor Vehicles, as set forth in paragraph 2, above. [ ] the assertion of a lien by retention of the vehicle from date vehicle removed/retained as set forth in paragraph 2, above. WHEREFORE, Plaintiff makes this affidavit for the purpose of foreclosing the lien upon the above described vehicle and prays that execution issue for: Removal Fee $ Accrued Storage Fee $ Future Storage Fee $ Other $ Advertising Cost $ Court Costs $ per day from date of filing this action. Sworn to and subscribed before me this [ ] Plaintiff day of , 20 [ ] Agent for Plaintiff . Address Clerk of Court/Notary Public Telephone No: AMV Affidavit 01/06/00 American LegalNet, Inc. www.USCourtForms.com