Form 78-009-10-8-1-000 "Affidavit of Abandonment and Motor Vehicle Sold" - Mississippi

What Is Form 78-009-10-8-1-000?

This is a legal form that was released by the Mississippi Department of Revenue - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the Mississippi Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 78-009-10-8-1-000 by clicking the link below or browse more documents and templates provided by the Mississippi Department of Revenue.

ADVERTISEMENT
ADVERTISEMENT

Download Form 78-009-10-8-1-000 "Affidavit of Abandonment and Motor Vehicle Sold" - Mississippi

1391 times
Rate (4.4 / 5) 69 votes
Form 78-009-10-8-1-000 Rev(09/17)
MISSISSIPPI
AFFIDAVIT OF ABANDONMENT AND MOTOR VEHICLE SOLD
Under the Mississippi Abandoned Motor Vehicle Law, Miss. Code Ann. Section 63-23-1, et seq., as amended, I/we being
persons defined therein authorized to proceed do hereby certify that on the
day of
, 20
the vehicle described below was abandoned on my premises.
VEHICLE IDENTIFICATION NUMBER (VIN):
YEAR:
MAKE:
LIST OR ITEMIZATION OF AUTOMOBILE SOLD
0
Storage
@
........................………………
$
Wrecker Service …………………………………………………………………………….
$
Labor …………………………………………………………………………………………
$
Parts ………………………………………………………………………..........................
$
0
Grand Total ………………………………………………………………………..
$
SOLD TO
(Print Name of Buyer)
(Printed Address of Buyer)
this the
day of
, 20
for $
Amount paid over to the Chancery Clerk $
(The proceeds of the sale in excess of repair, towing and storage
expenses and all expenses incurred in connection with a sale when a sale is made under the provisions of this act, shall
escheat to the county and shall be paid over to the Chancery Clerk to be placed into the general fund of the county in which the
vehicle is abandoned.)
Federal law and State law requires that you state the mileage in connection with the transfer of ownership. Failure to
complete or providing false statement may result in fines and/or imprisonment.
I,
, state that the odometer now reads
(NO TENTHS) miles and to the
best of my knowledge that the actual mileage of the vehicle described herein, unless one of the following statements is checked:
(1) I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits.
(2) I hereby certify that the odometer reading is NOT the actual mileage. WARNING – ODOMETER DISCREPANCY
(Printed Name of Seller)
(Printed Name of Buyer)
(Signature)
(Signature)
SUBSCRIBED AND SWORN TO BEFORE ME THIS
day of
, 20
.
(Notary Public)
Motor Vehicle Services
Phone 601-923-7200
FAX 601-923-7224
P.O. Box 1383 Jackson, MS 39215
www.dor.ms.gov
Form 78-009-10-8-1-000 Rev(09/17)
MISSISSIPPI
AFFIDAVIT OF ABANDONMENT AND MOTOR VEHICLE SOLD
Under the Mississippi Abandoned Motor Vehicle Law, Miss. Code Ann. Section 63-23-1, et seq., as amended, I/we being
persons defined therein authorized to proceed do hereby certify that on the
day of
, 20
the vehicle described below was abandoned on my premises.
VEHICLE IDENTIFICATION NUMBER (VIN):
YEAR:
MAKE:
LIST OR ITEMIZATION OF AUTOMOBILE SOLD
0
Storage
@
........................………………
$
Wrecker Service …………………………………………………………………………….
$
Labor …………………………………………………………………………………………
$
Parts ………………………………………………………………………..........................
$
0
Grand Total ………………………………………………………………………..
$
SOLD TO
(Print Name of Buyer)
(Printed Address of Buyer)
this the
day of
, 20
for $
Amount paid over to the Chancery Clerk $
(The proceeds of the sale in excess of repair, towing and storage
expenses and all expenses incurred in connection with a sale when a sale is made under the provisions of this act, shall
escheat to the county and shall be paid over to the Chancery Clerk to be placed into the general fund of the county in which the
vehicle is abandoned.)
Federal law and State law requires that you state the mileage in connection with the transfer of ownership. Failure to
complete or providing false statement may result in fines and/or imprisonment.
I,
, state that the odometer now reads
(NO TENTHS) miles and to the
best of my knowledge that the actual mileage of the vehicle described herein, unless one of the following statements is checked:
(1) I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits.
(2) I hereby certify that the odometer reading is NOT the actual mileage. WARNING – ODOMETER DISCREPANCY
(Printed Name of Seller)
(Printed Name of Buyer)
(Signature)
(Signature)
SUBSCRIBED AND SWORN TO BEFORE ME THIS
day of
, 20
.
(Notary Public)
Motor Vehicle Services
Phone 601-923-7200
FAX 601-923-7224
P.O. Box 1383 Jackson, MS 39215
www.dor.ms.gov