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Form 411219 (06-04)
AFFIDAVIT OF CORRECTION
Please read all instructions before completing this form.
This form may be accepted to correct information that has been written in error on a title, application for
title, damage disclosure statement, or other document required for title transfer or when these documents
contain an alteration or erasure. This affidavit cannot be used for odometer certification errors.
1.This affidavit can only be used to correct the errors identified.
2.All signatories to the original error, erasure, or alteration must sign this affidavit.
3.This affidavit must be completed in full, notarized, and attached to the document that contains the
error to be corrected.
4.Facsimiles and photocopies are not acceptable.
Subscribed and sworn to before me this day of ,
Title or MCO#
The sale date of was entered in error. The correct sale date is:
The seller signed his/her name in the incorrect space on the
The buyer signed his/her name in the incorrect space on the
Under penalty of perjury, the undersigned states that the above statements are true and correct and will
warrant and defend the title of any person to the described vehicle insofar as the claim rests upon the title
issued by virtue of this affidavit. The undersigned will protect and hold harmless the county treasurer or
Department of Transportation from any damages that might arise from the issuance of such title.
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