Form Mvd 10059 – Fill Out and Use This PDF

Lien Claimant affirms that the registered owner of the vehicle described below was justly indebted for services rendered as detailed in the Notice of Lien (Form 10058) and that all interested parties (including Lienholder if applicable) were notified by registered mail of the amount due. (Copies of notices of lien and registered mail return receipts must be attached.)

REGISTERED OWNER

NAME

ADDRESS

CITY, STATE, ZIP CODE

VEHICLE INFORMATION

THE VEHICLE WAS ADVERTISED FOR SALE AT PUBLIC AUCTION BY:

qAdvertising two (2) consecutive weeks in a newspaper of general circulation in the county where the auction was held. (Affidavit of publication and copy of advertisement attached.)

qPosting six (6) notices (handbills) in six (6) conspicuous public locations in the county where the auction was held. (Copy of notice / handbill attached.)

Noticeof#1Address: Noticeof#2Address: Noticeof#3Address: Noticeof#4Address: Noticeof#5Address: Noticeof#6Address:

PUBLIC AUCTION INFORMATION

Public auction was held by Lien Claimant on ____________________________________ ,		20 _______ at	________ qqAMPM
in the County of	_____________________________________________________________________ and specifically at:
ADDRESS	CITY	STATE	ZIP CODE

qThe highest (or only) acceptable bid received was for the exact sum of $ ___________________________________

andthevehiclewassoldto: Purchaser'sName Address

City, State, Zip Code

CAUTION: Iftheexactsumofthebidexceededthetotalindebtedness,theLienClaimantmustrefundtheexcessamount totheRegisteredOwneragainstwhomthelienwasclaimed.

- continued on back -

PUBLIC AUCTION INFORMATION CONTINUED

qNopersonappearedtobidorsubmitanyacceptableoffertopurchasethevehicleand,afterwaitingfifteen(15)minutes afterthespecifiedhouroftheauction,theLienClaimantbidonthevehiclefortheamountofthelienintheexactsum of $ ______________________________ .

NOTE: PURCHASER OR LIEN CLAIMANT (WHEN APPLICABLE) MUST APPLY FOR TITLE IN HIS / HER NAME AND PAY THE REGISTRATION AND TITLE FEES. PURCHASER MUST ALSO PAY EXCISE TAX.

ODOMETER MILEAGE STATEMENT

FEDERAL AND STATE LAW REQUIRES THE TRANSFEROR (SELLER) OF A VEHICLE TO STATE THE ODOMETER MILEAGE UPON TRANSFER OF OWNERSHIP. ANYONE CONVICTED OF A FRAUDULENT ODOMETER STATEMENT WILL BE SUBJECT TO FINES AND / OR IMPRISONMENT.

NOTE: THE DIVISION IS NOT RESPONSIBLE FOR FALSE OR FRAUDULENT ODOMETER STATEMENTS MADE IN CONNECTION WITH TRANSFER OF OWNERSHIP OR HELD LIABLE FOR RECORDING ERRORS.

I (Lien Claimant) hereby certify that the ODOMETER READING of the vehicle described above is:_____________________________

(notenths)milesandthattothebestofmyknowledgestatedmileageis(checkoneofthefollowing):

CERTIFICATION

Iherebycertifythatallinformationgiveninthisaffidavitis trueandcorrecttothebestofmyknowledge.

LienClaimant:

Address:

City, State, Zip Code:

SignatureofLienClaimantorAuthorizedAgent

Date

PrintedName:

PURCHASER'S ACKNOWLEDGEMENT

SignatureofPurchaserorAuthorizedAgent

Date

PrintedName:

NOTE

IF PROPERLY COMPLETED AND ACCOMPANYING DOCUMENTS ARE CORRECT AND IN ORDER, THIS AFFIDAVIT OF RESALE WILL SERVE AS AN ASSIGNMENT DOCUMENT AND A SEPARATE BILL OF SALE WILL NOT BE REQUIRED.