Form MVR-28 "Affidavit of Facts Surrounding the Incorrect Assignment of a Manufacturer's Certificate of Origin or a Certificate of Title" - North Carolina

What Is Form MVR-28?

This is a legal form that was released by the North Carolina Department of Transportation - Division of Motor Vehicles - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2006;
  • The latest edition provided by the North Carolina Department of Transportation - Division of Motor Vehicles;
  • 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 MVR-28 by clicking the link below or browse more documents and templates provided by the North Carolina Department of Transportation - Division of Motor Vehicles.

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Download Form MVR-28 "Affidavit of Facts Surrounding the Incorrect Assignment of a Manufacturer's Certificate of Origin or a Certificate of Title" - North Carolina

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North Carolina Division of Motor Vehicles
MVR-28 (Rev. 1/06)
AFFIDAVIT OF FACTS SURROUNDING THE INCORRECT ASSIGNMENT OF A
MANUFACTURER’S CERTIFICATE OF ORIGIN OR A CERTIFICATE OF TITLE
1
Seller/s____________________________________________________________________________________________________________________
(NAME/S AND ADDRESS)
This will certify that I/we did not sell or deliver a ____________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
_______________________________
__________________________________________________________________________ .
to
(VEHICLE IDENTIFICATION NUMBER)
(PURCHASER/S)
I/we did sell and deliver a __________________________________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
(VEHICLE IDENTIFICATION NUMBER)
The incorrect manufacturer’s certificate of origin or the incorrect certificate of title number _________________________ was assigned.
__________________________________________________________________________________________________________________________
(SIGNATURE/S OF SELLER/S)
By: _______________________________________________________________________________________________________________________
(AUTHORIZED REPRESENTATIVE)
Date __________________
County ______________________________________________
State__________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily
signed the foregoing document for the purpose stated therein and in the capacity indicated:
____________________________________________________________________________________________ (NAME(S) OF PRINCIPAL(S))
Notary
Notary Printed
Signature____________________________________________
or Typed Name ______________________________________
My Commission Expires ______________________________
(SEAL)
2
Purchaser/s________________________________________________________________________________________________________________
(NAME/S AND ADDRESS)
This will certify that I/we did not purchase or take delivery of _________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
____________________________
__________________________________________________________________________ .
from
(VEHICLE IDENTIFICATION NUMBER)
(SELLER’S NAME/S)
I/we did purchase and take delivery of _______________________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
(VEHICLE IDENTIFICATION NUMBER)
The incorrect manufacturer’s certificate of origin or the incorrect certificate of title number _________________________ was assigned.
__________________________________________________________________________________________________________________________
(SIGNATURE/S OF PURCHASER/S)
Date __________________
County ______________________________________________
State__________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily
signed the foregoing document for the purpose stated therein and in the capacity indicated:
____________________________________________________________________________________________ (NAME(S) OF PRINCIPAL(S))
Notary
Notary Printed
Signature____________________________________________
or Typed Name ______________________________________
My Commission Expires ______________________________
(SEAL)
3
Lienholder ________________________________________________________________________________________________________________
(NAME AND ADDRESS)
This will certify that we hold no interest whatsoever in a _____________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
________________________________
for which the manufacturer’s certificate of origin or certificate of title number ______________
(VEHICLE IDENTIFICATION NUMBER)
was assigned in error to ____________________________________________________________________________________________________
We do hold a security agreement on a _______________________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
(VEHICLE IDENTIFICATION NUMBER)
__________________________________________________________________________________________________________________________
(LIENHOLDER)
By: _______________________________________________________________________________________________________________________
(AUTHORIZED REPRESENTATIVE)
Date __________________
County ______________________________________________
State__________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily
signed the foregoing document for the purpose stated therein and in the capacity indicated:
____________________________________________________________________________________________ (NAME(S) OF PRINCIPAL(S))
Notary
Notary Printed
Signature____________________________________________
or Typed Name ______________________________________
My Commission Expires ______________________________
(SEAL)
North Carolina Division of Motor Vehicles
MVR-28 (Rev. 1/06)
AFFIDAVIT OF FACTS SURROUNDING THE INCORRECT ASSIGNMENT OF A
MANUFACTURER’S CERTIFICATE OF ORIGIN OR A CERTIFICATE OF TITLE
1
Seller/s____________________________________________________________________________________________________________________
(NAME/S AND ADDRESS)
This will certify that I/we did not sell or deliver a ____________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
_______________________________
__________________________________________________________________________ .
to
(VEHICLE IDENTIFICATION NUMBER)
(PURCHASER/S)
I/we did sell and deliver a __________________________________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
(VEHICLE IDENTIFICATION NUMBER)
The incorrect manufacturer’s certificate of origin or the incorrect certificate of title number _________________________ was assigned.
__________________________________________________________________________________________________________________________
(SIGNATURE/S OF SELLER/S)
By: _______________________________________________________________________________________________________________________
(AUTHORIZED REPRESENTATIVE)
Date __________________
County ______________________________________________
State__________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily
signed the foregoing document for the purpose stated therein and in the capacity indicated:
____________________________________________________________________________________________ (NAME(S) OF PRINCIPAL(S))
Notary
Notary Printed
Signature____________________________________________
or Typed Name ______________________________________
My Commission Expires ______________________________
(SEAL)
2
Purchaser/s________________________________________________________________________________________________________________
(NAME/S AND ADDRESS)
This will certify that I/we did not purchase or take delivery of _________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
____________________________
__________________________________________________________________________ .
from
(VEHICLE IDENTIFICATION NUMBER)
(SELLER’S NAME/S)
I/we did purchase and take delivery of _______________________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
(VEHICLE IDENTIFICATION NUMBER)
The incorrect manufacturer’s certificate of origin or the incorrect certificate of title number _________________________ was assigned.
__________________________________________________________________________________________________________________________
(SIGNATURE/S OF PURCHASER/S)
Date __________________
County ______________________________________________
State__________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily
signed the foregoing document for the purpose stated therein and in the capacity indicated:
____________________________________________________________________________________________ (NAME(S) OF PRINCIPAL(S))
Notary
Notary Printed
Signature____________________________________________
or Typed Name ______________________________________
My Commission Expires ______________________________
(SEAL)
3
Lienholder ________________________________________________________________________________________________________________
(NAME AND ADDRESS)
This will certify that we hold no interest whatsoever in a _____________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
________________________________
for which the manufacturer’s certificate of origin or certificate of title number ______________
(VEHICLE IDENTIFICATION NUMBER)
was assigned in error to ____________________________________________________________________________________________________
We do hold a security agreement on a _______________________________________________________________________________________
(YEAR)
(MAKE)
(BODY STYLE)
(VEHICLE IDENTIFICATION NUMBER)
__________________________________________________________________________________________________________________________
(LIENHOLDER)
By: _______________________________________________________________________________________________________________________
(AUTHORIZED REPRESENTATIVE)
Date __________________
County ______________________________________________
State__________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily
signed the foregoing document for the purpose stated therein and in the capacity indicated:
____________________________________________________________________________________________ (NAME(S) OF PRINCIPAL(S))
Notary
Notary Printed
Signature____________________________________________
or Typed Name ______________________________________
My Commission Expires ______________________________
(SEAL)