Affidavit of Fact

The following described vehicle:

Erasure or Alteration was made due to:

VIN #:

Seller:

Purchaser:

Typographical Error

Customer changed mind, did not take possession

Purchaser's name misspelled

Correct Date of Sale to

Correct Odometer to

Other, Explain:

Seller(s)'s Signature Purchaser(s)'s Signature

Date Date

400 N. San Jacinto St. Conroe, Texas 77301

(936) 539-7897 (281) 354-5511 ext 7897

Tammy J. McRae Tax Assessor-Collector Montgomery County

Rev

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