New Jersey Motor Vehicle Commission P.O. Box 017 Trenton, NJ 08666-0017 STATE OF NEW JERSEY 1-888-486-3339 ext. 5070 (in state) 1-609-292-6500 ext. 5070 (out of state) Application for Repossession Certificate of Ownership Certification of Compliance with Article 9 of the New Jersey Uniform Commercial Code Secured The vehicle described below was repossessed on date: ________________ and was disposed of pursuant to the provisions of Article 9 of the New Jersey Uniform Commercial Code on the date shown below. Name of Secured Party Street Address City State Zip City State Zip Debtor Name of Debtor Street Address Vehicle Vehicle Identification Number Year Body Type Make Present Odometer Reading Model Color Title Transferee Note: If the lienholder/secured party is taking title, the below section must be completed and signed. Name of Buyer or Lienholder taking title Date of Sale Street Address City Driver License No. (If business, corpcode) Sex State Eye Color Zip Date of Birth Signature of Buyer or Lienholder taking title: ___________________________________________________________ I, the undersigned, do hereby certify that I am the secured party mentioned in the foregoing application, that the repossessed vehicle has been disposed of pursuant to the provisions of Article 9 of the New Jersey Uniform Commercial Code and that the information contained herein is true to the best of my knowledge. Signature and title of secured party : ______________________________________________________________________ Please note: N.J.S.A. 39:10-11 required that this assignment and New Jersey title papers be presented to the NJ Motor Vehicle Commission within 10 days; failure to do so will result in a penalty of $25, in addition to the filing and issuing fee of the new title. Forward a $60.00 check or money order made payable to “NJMVC”, with a copy of the security agreement, notice of sale to the owner/debtor, and the certificate of ownership. Only mail documents to: NJ Motor Vehicle Commission – Repossession Unit, 225 E. State Street, P.O. Box 017, Trenton, NJ 08666-0017. Dealer Tax Stamp Purchase Price $ ________________________ Sales/ Use Tax $ ________________________ Ex Code OS/SS-57 (R7/09) Initials American LegalNet, Inc. www.FormsWorkFlow.com