ANTHONY J. DATTILIO CLERK OF COURTS COLUMBIANA COUNTY, OHIO CHANGE OF ADDRESS STATE OF OHIO COLUMBIANA COUNTY I, do hereby make an affidavit that I have moved. New Address: Former Address: I require a Certificate of Title for this vehicle and ask the Clerk of Courts to issue me a Certificate of Title showing the new address where I am presently residing. The Clerk of Courts and any of his Deputy Clerks shall be kept free and harmless of any and all liability against this vehicle at any time. Signature of Affiant ( Seal ) Sworn to and subscribed in my presence this day of , 20 . Clerk of Courts, Deputy Clerk, Notary Public P.O. Box 349 LISBON, OHIO 44432 LEGAL (330) 424-7777 AUTO TITLE (330) 424-6665 American LegalNet, Inc. www.USCourtForms.com