Danny N. Crank, Butler County Recorder Form 72 Affidavit for New Duplicate of Lost or Destroyed Certificate of Title State of Ohio, __________________, County, SS: ___________________________________________ being first duly sworn, says that _______ full name(s) is/are _____________________________________________________, that _________ reside(s) in the County of _______________, State of _____________, that _______ P.O. address is _____________________________________________ and that ______ is/are the identical person (s) to whom Certificate of Title No. _______ was issued on the ______ day of _________________, _________, the same appearing in Registration Book ______, Page ______ of ______________ County, Ohio; that a Duplicate of said certificate of title was duly issued and delivered to _________ on the _______ day of _________________, ______, but that said duplicate has become LOST or DESTROYED (circle one) and that affiant(s) is/are now unable to produce the same. Affiant(s) further on oath say(s) that ________ has/have not in any way or for any purpose whatsoever voluntarily parted with, assigned, transferred or delivered said duplicate certificate of title to any person or persons, partnership, firm or corporation, and that this affidavit and application is in good faith made for the purpose of obtaining a new duplicate of said certificate of title. ______________________________ ______________________________ Sworn to and subscribed before me this ________ day of ___________________, 20___. ______________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com