VOLUNTARY ASSIGNMENT OF TITLE BY BORROWER TO LIENHOLDER ERASURES AND ALTERATIONS VOID THIS TITLE ASSIGNMENT. (Type or print in ink.) ASSIGNMENT OF OWNERSHIP I (we) certify this motor vehicle Year ________ Make __________________ VIN ______________________________________ was delivered on ___/___/____for the purpose of voluntary repossession to: Is Transferor a Minor? ÿ Yes ÿ No Transferee’s printed name __________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ODOMETER CERTIFICATION Federal and State laws require that you state the mileage in connection with transfer of ownership. Failure to complete or providing false information may result in fines and/or imprisonment. thousands ' ' ', ' ' ' no tenths miles I (we) certify to the best of my (our) knowledge that the odometer now reads and is the actual mileage of the vehicle unless one of the following statements is checked. 'The mileage stated is in excess of ' The Odometer reading is not the actual mileage. the mechanical limits. WARNING – ODOMETER DISCREPANCY -----------------------------------------------------------------------------------------------------------------------------------------------------------------This vehicle was a (if applicable): ÿ Former Law Enforcement Vehicle ÿ Former Taxi ÿ Flood Vehicle _____________________________________________________ Transferor’s printed name X______________________________________________ Transferor’s signature __________________________________________________________________________________________________________ Transferor’s printed address NOTE: All blank spaces above must be completed before acknowledgement. Sworn to and subscribed in my presence by __________________________________this_______ day of _______________ , 20 _____________. My commission expires______________ , 20 _____. (seal) Clerk, Deputy Clerk of Courts – Notary ________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ TRANSFEREE’S ACKNOWLEDGEMENT OF ABOVE ODOMETER CERTIFICATION ______________________________________________________ Transferee’s printed name P-076a X____________________________________ Transferee’s signature American LegalNet, Inc. www.FormsWorkflow.com