Transcription of AFFIDAVIT OF REPOSSESSION - Connecticut
1 STATE OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLESTITLE SECTION60 STATE STREET, WETHERSFIELD CT 06161On The Web At OF REPOSSESSIONDATE:I,, of, do hereby swear that there was due from(Name of Lienholder)(Address of Lienholder)(Name of Debtor), of(Address of Debtor)the sum of $, secured by a valid lien dated, 20on amotor vehicle described as follows:MAKEMODELIDENTIFICATION STYLEYEARMOTOR , I further swear that default having been made in the payment by said date, that the debtorvoluntarily surrendered possession of said vehicle to the undersigned lienholder on _____,20 ___, under accordance with the lien contract.(Or) I further swear that default having been made in the payment of said debt, lienholder seized saidvehicle without process of law on _____, 20 ___, under authority of the conditions ofthe lien undersigned lienholder hereby certifies that the motor vehicle described herein was lawfullyrepossessed under the terms of a valid security agreement and in full accord with the pertinent sectionsof the General Statutes of the State of Connecticut as amended.
2 (Name of Lienholder)(Corporation, Officer, Trustee, Partner)SIGNATURE BY:Before me personally appeared _____, who by me being dulysworn upon oath says that the statements set forth above are true and and sworn to before me this _____ day of _____, 20 of Superior Court, Notary Public, Justice of the PeaceH-30 REV. 6-2001
