Transcription of STATEMENT OF ERROR, CORRECTION, MOTOR VEHICLE …
1 STATEMENT OF ERROR, correction , OR ALTERATION north dakota department of transportation , MOTOR VEHICLE SFN 2964 (4-2019) MOTOR VEHICLE DIVISION ND DEPT OF transportation 608 E BOULEVARD AVE BISMARCK ND 58505-0780 Telephone (701)328-2725 Website: correcting an error or alteration for the buyer's name, date of sale, selling price, or odometer reading, this form must be completed and signed by the seller. For all other errors and alterations, this form must be completed and signed by the individual who originally made the error or Identification NumberTitle NumberName of Seller(s)/Transferor:Check the correction (s) that need to be applied: The correct Name of Buyer(s)/Transferee is: The Odometer Reading is altered/incorrect. Correct Odometer reading:A separate conforming secure odometer disclosure is also required (SFN 18773). *If the title was issued with an incorrect odometer reading an Odometer correction (SFN 60806) must be completed. The correct Date of Sale is: The correct Selling Price is: Other: (Explain error or alteration below AND what correction (s) should be applied.)
2 Name (Type or Print)Legal Signature (sign before a Notary Public or Authorized Officer)AcknowledgementState ofCounty of Signed and sworn to (or affirmed) before me on this day(month, day, year)Name of Notary Public or other Authorized Officer (Type or Print)Signature of Notary Public or other Authorized OfficerCommission Expiration Date (if not listed on stamp)Affix Notary StampUnder penalties of perjury, I certify that the information on this request is correct to the best of my knowledge.
