Transcript
South Carolina Department of Motor Vehicles
4034 (Rev.3/04)
AFFIDAVIT FOR REPOSSESSED MOTOR VEHICLE (Entire Form to be Typed or Printed)
Under penalties of perjury, I ______________________________________ certify that all facts set forth herein are true and correct and further certify that the holders of other unsatisfied liens recorded against this vehicle on the records, Department of Motor Vehicles, Blythewood, S.C., have been duly notified to protect their interest in the vehicle, if any, and this is to certify that the undersigned has repossessed the motor vehicle described below because of the failure of the former owner to meet this obligation for settlement of a lien or mortgage on said vehicle. _____________________________________________________________________________________________ Name of Owner from Whom Vehicle Repossessed _____________________________________________________________________________________________ Street City State Zip Code _____________________________________________________________________________________________ Make Vehicle Identification Number (Serial) Title Number _____________________________________________________________________________________________ Year Model Current License Number License Year Body Style
Method of Repossession _____ Voluntary
_____ Terms of Lien or Mortgage _____ Public Sale
(IF BY PUBLIC SALE ATTACH BILL OF SALE OF SHERIFF OR AUTHORIZED SELLER)
Amount of Original Lien: $ _______________________
Date of Lien: _____________________________
Lienholder’s Name: ____________________________________________________________________________ Street, City, State, Zip Code: _____________________________________________________________________ Date of Repossession: __________________________________________________________________________ Signature of Lienholder: ___________________________________________ Title:________________________ Furthermore, this is to certify that for the value received $ ______________ the above vehicle has been assigned to: _____________________________________________________________________________________________ NAME STREET CITY STATE ZIP CODE for disposition or sale. By: __________________________________________ Date: ________________________________________ Sales Tax Number: _____________________________ NOTICE:
This form must accompany the Certificate of Title, which must be properly assigned to the new owner on the back of the title. (See instructions on reverse side)
South Carolina Department of Motor Vehicles
4034 (Rev.3/04)
AFFIDAVIT FOR REPOSSESSED MOTOR VEHICLE
REPOSSESSION
1. To register a repossessed vehicle, the following forms are required: S.C. title showing recorded lien Form 400 – Application for Title and Registration Form 4034 – Repossession Affidavit Form 4031 – Secured Bill of Sale 2. The Form 400 should be completed by the applicant for registration and title. A license plate may be transferred from a vehicle of the same general classification owned by the same person to this newly acquired vehicle, otherwise, a paid tax receipt must be furnished and a new license plate purchased. 3. The Form 4034 must be completed in every detail, and submitted with the title. When reassigned, if the sales tax is collected, enter sales tax number in the space provided on reverse side of this affidavit. AN INCOMPLETE AFFIDAVIT WILL BE RETURNED. Particular attention is called to the paragraph beginning with “Under penalties of perjury…”. This paragraph now requires certification that all other leinholders have been notified as well as that all facts stated are true and correct. 4. The Certificate of Title must be assigned and on S.C. Titles dated prior to June 19, 1989, the Form 4031 must be completed in detail indicating the sales price and odometer mileage of the vehicle. 5. To register a repossessed vehicle registered in another state, the application must be accompanied by the out-of-state title or if from a non-title state, the registration of the former owner must accompany the application. Verification by the out-of-state Bureau of Motor Vehicles may be acceptable. 6. Value received is necessary in cases when excise or use taxes must be collected by the South Carolina Department of Motor Vehicles.
