Affidavit of Correction Form - Mississippi

AFFIDAVIT OF CORRECTION
Title Bureau P. O. Box 1033 Jackson, MS 39215 www.dor.ms.gov Phone 601-923-7643 FAX 601-923-7224
Date: ___________________________
To Whom It May Concern:
The strikeover on the assignment of the attached Manufacturer’s Certificate of Origin or Certificate of Title for
the following described motor vehicle:
Year: ________________ Make: ________________________ Model: _________________________
Vehicle Identification Number (VIN): ____________________________________________________________
was made due to the following reason(s):
___ Typographical error ___ Assignment placed in dealer assignment in error
___ Customer changed mind ___ Notary Public placed signature in wrong space
___ Seller signed their name incorrectly ___ Purchaser’s name misspelled
___ Seller assigned title to wrong party ___ Seller made strikeover in purchaser’s name
___ Other: _________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Sworn to and subscribed before me this _______day of __________________________________, 20________.
_________________________________________ ______________________________________________
Signature Signature
Notary
__________________________________________ Seal
Notary Public’s Signature
IMPORTANT: The person(s) who was required to complete the assignment where the correction has been made
must complete this form. This form cannot be used when information has been blocked out by erasure or the use
of correction fluid/tape. In these cases, replacement documents must be obtained. This form cannot be used to
correct an odometer reading, a purchase date, or an incorrectly recorded lien, or security interest holder. For an
incorrectly recorded lien or security interest holder, a release of lien or security interest must be obtained by the
incorrectly recorded lien or security interest holder and submitted.
Form 78-008-10
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