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AFFIDAVIT OF REPOSSESSION
STATE OF RHODE ISLAND -- DIVISION OF MOTOR VEHICLES
600 New London Avenue ,Cranston, RI 02920-3024
Lien holder Name:
Lien holder Address:
Debtor: Amount Due:
Lien Date: VIN:
Year: Make: Model: Body: Cyl:
I hereby certify that as the lien holder there were funds due from the above named debtor, these funds were
secured by a valid lien on the date stated above, for the vehicle described.
I further certify that default having been made in the payment of said loan that: (check one)
The debtor voluntarily surrendered the possession of said vehicle to the lien holder on
The lien holder seized said vehicle without process of law on ______________________ under
authority of the conditions of the lien contract.
The undersigned lien holder further certifies that the vehicle described herein was lawfully repossessed under
the terms of a valid security agreement and in full accord with the pertinent sections of the General Laws of
the State of Rhode Island, as
Name of Lien Holder:
Before me personally appeared _________________________, who by me being duly sworn under oath says
the statements set forth above are true and correct.
Subscribed and sworn to before me this ______________ day of ___________________, 20____.
Attach this original to Certificate of Title.
The lien must be released on the face of the title.
This form cannot be used to transfer ownership. Assign ownership to the purchaser on the reverse side
of the title, including the full odometer disclosure.
This affidavit is for use by lending institutions when a vehicle is repossessed.
It should be completed and signed by an authorized representative of the lending institution and should be notarized.
The lending institution should release the lien on the Certificate of Title, assign ownership to the purchaser and disclose
the odometer mileage in the spaces provided on the reverse side of the Certificate of Title.
This affidavit should then be attached to the Certificate of Title and be given to the purchaser.
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