Arizona Repossession Affidavit – Fill Out and Use This PDF

Enter the Vehicle Identification Number, the Year and the Make.

Enter the Registered Owner Names (printed), the Repossession Date and the Title State.

"I certify that I am the legal owner and a lienholder of record for the vehicle described above, that the vehicle is physically located in Arizona and that I repossessed the vehicle upon default pursuant to the terms of the lien and all applicable laws and regulations, and that the State of Arizona, its agencies, employees and agents shall not be held liable for relying on the contents of this affidavit."

Enter the Lienholder Company Name and the Lienholder Agent Name, and the Lienholder Signature.

Under BILL OF SALE: "I hereby sell to the Buyer, the vehicle described above."

Enter the Buyer Name and the Sale Date.

Enter the Street Address, City, State and Zip.

Enter the Name of New Lienholder; if no lien, write NONE. Enter the Lien Date.

Federal and State law require that the seller states the mileage in connection with the transfer of ownership.

Enter the Odometer Reading (no tenths) and mark miles or kilometers.

The odometer reading is the actual mileage unless one of these boxes is checked: Mileage in excess of the odometer mechanical limits, or NOT Actual Mileage, WARNING - ODOMETER DISCREPANCY.

"I certify to the best of my knowledge that the odometer reading is the actual mileage unless one of the boxes above is checked."

Failure to complete the odometer statement, or providing a false statement, may result in fines and/or imprisonment.

The seller enters the Seller Name (printed), the Seller Signature and the Date, and the Street Address, City, State and Zip.

The buyer, who is aware of the odometer certification made by the seller, enters the Buyer Name (printed), the Buyer Signature and the Date.