Affidavit of Ownership by Repossession

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AFFIDAVIT OF

OWNERSHIP BY REPOSSESSION
This form is for Nebraska lienholders only. Out-of-state
lienholders must use a form approved by their state of
residence.

I being duly sworn deposes and say that


Representative of Secured Party

is/are the lawful owner(s) of the following


Secured Party

described motor vehicle/motorboat due to repossession.

Year Make Model

Vehicle Identification Number/Hull Identification Number

I further depose that:

1. the debtor has defaulted in connection with an obligation secured by the vehicle/boat
specified above;
2. we have exercised our post-default remedies with respect to this collateral;
3. by reason of this exercise, we are acquiring the rights of the debtor in this collateral.

Repossessed from
Name of Debtor

Address City State Zip

Date of Original Contract

Date of Transfer of Ownership

Affiant swears that he/she is making this statement for the purpose of having the designated County
Official issue a Certificate of Title in his/her name as indicated by the attached Application for Certificate
of Title.

Affiant swears that he/she will warrant and defend the title and rights of this motor vehicle and protect the
issuing designated County Official from any damages that might arise from irregularities on same.

Signature of Representative of Secured Party Printed Name of Representative of Secured Party

Subscribed and Sworn to before me this day of ,

Notary Public
Seal

 The lien shall not be released on the face of the title accompanying this Affidavit.
 The date of Transfer of Ownership recorded above must be equal to or less than the notary date.
 The date of Transfer of Ownership will be used as the purchase date on the Certificate of Title
issued pursuant to this Affidavit.
Revised 9/2020

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