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Get MS DoR 78-013-10

AFFIDAVIT OF OWNERSHIP OF MOTOR VEHICLE FOR WHICH APPLICATION FOR TITLE UNDER BOND OR CASH IS MADE MVCT-59 from Department of Public Safety Required Form 78-013-10 THE STATE OF MISSISSIPPI COUNTY OF Before me the undersigned has this day appeared of Name Street Address who after being duly sworn deposes and states that he she is the legal City State Zip Owner by virtue of the attached bill of sale of the following described vehicle VIN YEAR MAKE And states that said vehicle was acquired from whose address Enter Name of Person You Acquired Vehcile From Attach Bill of Sale Telephone number at which the seller may be reached. In what state was the herein described Required vehicle last registered In your own words state the reason you are unable to surrender the current Certificate of Title of the vehicle. Was there a license tag on the vehicle when you acquired it If so give state and tag number. Instructions The vehicle described herein must be taken to the nearest Mississippi Department of Public Safety substation for inspection and issuance of Form MVCT-59 by the inspecting officer prior to making application for certificate of title. Federal law and State law requires that you state the mileage in connection with the transfer of ownership* Failure to complete or providing false statement may result in fines and/or imprisonment. best of my knowledge that the actual mileage of the vehicle described herein unless one of the following statements is checked 1 I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. Printed Name of Buyer Signature SUBSCRIBED AND SWORN TO BEFORE ME THIS day of 20. This form is required to be submitted with all Applications for Certificate of Title made under Title Bond Notary Public Title Bureau P. In what state was the herein described Required vehicle last registered In your own words state the reason you are unable to surrender the current Certificate of Title of the vehicle. Was there a license tag on the vehicle when you acquired it If so give state and tag number. Instructions The vehicle described herein must be taken to the nearest Mississippi Department of Public Safety substation for inspection and issuance of Form MVCT-59 by the inspecting officer prior to making application for certificate of title. Was there a license tag on the vehicle when you acquired it If so give state and tag number. Instructions The vehicle described herein must be taken to the nearest Mississippi Department of Public Safety substation for inspection and issuance of Form MVCT-59 by the inspecting officer prior to making application for certificate of title. Federal law and State law requires that you state the mileage in connection with the transfer of ownership* Failure to complete or providing false statement may result in fines and/or imprisonment. Federal law and State law requires that you state the mileage in connection with the transfer of ownership* Failure to complete or providing false statement may result in fines and/or imprisonment. best of my knowledge that the actual mileage of the vehicle described herein unless one of the following statements is checked 1 I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. .

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