Anthony J. Dattilio Columbiana County Clerk of Courts ATV or Off-highway motorcycle Affidavit of Ownership This form must be completed and surrendered to the Clerk of Courts prior to issuance of initial title Type or Print in ink State of Ohio, County of Owners nam e SSN/EIN Owners address The above named individual hereby declares under penalty of perjury that he/she is the lawful owner or purchaser of the following described ATV or off-highway motorcycle: Year Make VIN Body type Model and that, to the best of my knowledge, the above-described ATV or off-highway motorcycle has never been titled in the State of Ohio. The above-described ATV or off-highway motorcycle was acquired how? When? From whom? Is purchaser a minor? Yes No Date of birth The following is a full statement of all liens; mortgages or encumbrances on said ATV or off-highway motorcycle: Name of lien holder Address of lien holder If there is a lien, the security agreement MUST be presented to the Clerk of Courts office at the time of title issuance. If no lien, state "NONE" here Owners signatur e Sworn to and subscribed in my presence by this day of day month year Clerk, Deputy Clerk of Courts, Notary My Commission expires (seal) American LegalNet, Inc. www.USCourtForms.com