MV-950 (1/11) PAGE 1 OF 2 New York State Department of Motor Vehicles AFFIRMATION OF REPOSSESSION AND BILL OF SALE www.dmv.ny.gov Lenders must complete boxes 1 INSTRUCTIONS 2 3 4 5 If Lender is selling vehicle, Purchaser information is required in boxes 5 6 1 VEHICLE DESCRIPTION (includes motor vehicle or motorcycle, manufactured home* or boat * ) YEAR MAKE STATE LAST REG MODEL STATE LAST TITLED PLATE NUMBER VEHICLE IDENTIFICATION NUMBER 2 LENDER BORROWER Business Name Last Name, First, M.I. Number and Street Address Apt. No. State City ZIP Code Apt. No. Number and Street Address City State ZIP Code The vehicle described above was repossessed in _______________________ on ______________ from the borrower who was in default (State) of a security contract dated _______________ . On ________________ , ______________________________________________ was (Auctioneer) (Month/Day/Year) authorized to sell the above vehicle (if applicable). Section 425(1) of the Vehicle and Traffic Law requires that, when a motor vehicle or motorcycle is repossessed, proper notification must be provided to the parties listed below, within 24 hours. (*NOTE: This notification is not required when a manufactured home or boat is repossessed.) 3 PROPER NOTICE HAS BEEN GIVEN TO THE FOLLOWING PARTIES (list names and addresses ): Police Agency Name Commissioner of Motor Vehicles (enter Name of Motor Vehicles office notified) Borrower/Current Owner Name (other than lienholder) Other Name Date Notified Address Address Address Address Under the penalties of perjury, I affirm that I have complied with Section 425(1) of the New York State Vehicle and Traffic Law (see page 2) and/or any applicable laws in the state where the vehicle was repossessed, pertaining to the repossession of the vehicle described above. I further affirm that, if there are any other open perfected liens on the vehicle, and a lien release is not obtained, I have advised the purchaser of the outstanding liens on the vehicle. ± (Lender’s Signature) 4 ODOMETER DISCLOSURE STATEMENT The odometer on the vehicle described above has (check the appropriate box): 5 digits 6 digits 7 digits, not including tenths. Federal and state laws require that the mileage of the vehicle described above be specified upon transfer of ownership. Failure to do so, or not telling the truth about mileage, may result in fines and/or imprisonment. I, _______________________________________________________ state that the odometer now reads ______________________ miles (do not include tenths of a mile) Lender – Print Name in Full and (one of the following statements must be checked): 1. I certify that, to the best of my knowledge, this odometer reading reflects the “ACTUAL MILEAGE” as seen on the odometer of the vehicle described above. 2. I certify that, to the best of my knowledge, the above-disclosed odometer reading “EXCEEDS MECHANICAL LIMITS”. (The mileage is in excess of what the odometer is capable of recording.) 3. I certify that, to the best of my knowledge, the above-disclosed odometer reading is “NOT THE ACTUAL MILEAGE. WARNING: ODOMETER DISCREPANCY.” 5 DAMAGE DISCLOSURE STATEMENT IMPORTANT: Making a false statement, or failure to accurately disclose the salvage status of a vehicle, may subject you to substantial civil fines, in addition to any penalties authorized by the Penal Law. Check one box– I certify that, to the best of my knowledge, this vehicle has been has not been wrecked, destroyed or damaged to such an extent that the total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and for legal operation on the road or highways, is more than 75% of the retail value of the vehicle at the time of loss. (Checking the “has been” box means the vehicle must have an anti-theft examination before being registered, and that the title issued will have the statement “Rebuilt Salvage: NY” on it.) ± Lender Signature ± Purchaser Signature 6 PURCHASER: Print Last Name, First, M.I. Number and Street Address Price Paid Apt. No. City Date of Sale State ZIP Code American LegalNet, Inc. www.FormsWorkFlow.com MV-950 (1/11) § PAGE 2 OF 2 425. Repossession of motor vehicle or motorcycle; garageman’s lien; notice to police. 1. Any person, firm or corporation, or agent, employee or representative thereof, repossessing or retaking a motor vehicle or motorcycle pursuant to the provisions of article nine of the uniform commercial code, or other authority of law, or any contract or agreement, shall, immediately following such repossession or retaking, personally appear at a station house or other office of the police department, or agency or officer performing like functions, in the locality wherein such repossession or retaking occurred, give notice to such department, agency or officer of such repossession or retaking and thereafter and within twenty-four hours personally deliver or mail by special delivery first class mail to the nearest motor vehicle district office, (a) notice of such repossession or retaking in such form as the commissioner may require and (b) the number plates of such motor vehicle or motorcycle. Notice of such repossession or retaking, including the name and address of the person, firm or corporation repossessing or retaking the same, shall also be given within twenty-four hours thereof to the owner of such motor vehicle or motorcycle, either personally or by registered or certified mail directed to such owner at his last-known address. Unless the motor vehicle or motorcycle can be repossessed or retaken without breach of the peace, it shall be repossessed or retaken by legal process, but nothing herein contained shall be construed to authorize a violation of the criminal law. American LegalNet, Inc. www.FormsWorkFlow.com