Secretary of State Affirmation of Correction

Secretary of State
Affirmation of Correction
Secretary of State
Vehicle Services Department
014 Howlett Bldg.
Springfield, IL 62756
217-785-3000
www.cyberdriveillinois.com
This space for use by
Secretary of State.
Check statement that applies:
1. I/We release all interest in the License Plate/Vehicle (circle one or both) mentioned above and request that all said
interest be transferred to: ____________________________________________________________.
This release applies to joint ownership only.
(Each person releasing interest must sign in signature area below.)
2. Seller/Purchaser (circle one or both) signed his/her name(s) in incorrect space.
(Person making statement must sign in signature area below.)
3. Purchaser changed his/her mind and did not take possession of vehicle.
The vehicle was actually sold to: __________________________________________________.
(Each seller and incorrect purchaser must sign in signature area below.)
4. The correct Date of Sale is: ______________________________________________________.
The date of ________________________ was entered in error.
(Each buyer and seller must sign in signature area below.)
5. The Name of the Purchaser/Seller (circle one or both) was misspelled on the Assignment of Title.
The name is spelled correctly on the application.
(Person making statement must sign in signature area below.)
6. I state that _________________________________________________ and
_________________________________________________ are one and the same person.
(Person making statement must sign in signature area below.)
7. My name was entered in error as the Lienholder on the title document(s).
I do not hold any interest or lien on this vehicle.
(Person making statement must sign in signature area below.)
NOTE: THIS AFFIRMATION CANNOT BE USED FOR ODOMETER DISCLOSURE OR CORRECTIONS.
Under penalties of perjury, the undersigned states that the above statements are true and correct and will assume all
liability and costs for any litigation that may arise from the issuance of this Certificate of Title.
Printed on recycled paper. Printed by authority of the State of Illinois. September 2012 — 75M — VSD 393.8
Changes are necessary to documents that have been completed incorrectly for the following vehicle:
_____________ ________________________ _____________________________________ _______________
Year Make VIN Plate #
Signatures
______________________________________________ ______________________________________________
Signature of Seller Signature of Buyer
______________________________________________ ______________________________________________
Signature of Co-Seller Signature of Co-Buyer
______________________________________________ ______________________________________________
Date Date
Secretary of State
Affirmation of Correction
Secretary of State
Vehicle Services Department
014 Howlett Bldg.
Springfield, IL 62756
217-785-3000
www.cyberdriveillinois.com
This space for use by
Secretary of State.
Check statement that applies:
1. I/We release all interest in the License Plate/Vehicle (circle one or both) mentioned above and request that all said
interest be transferred to: ____________________________________________________________.
This release applies to joint ownership only.
(Each person releasing interest must sign in signature area below.)
2. Seller/Purchaser (circle one or both) signed his/her name(s) in incorrect space.
(Person making statement must sign in signature area below.)
3. Purchaser changed his/her mind and did not take possession of vehicle.
The vehicle was actually sold to: __________________________________________________.
(Each seller and incorrect purchaser must sign in signature area below.)
4. The correct Date of Sale is: ______________________________________________________.
The date of ________________________ was entered in error.
(Each buyer and seller must sign in signature area below.)
5. The Name of the Purchaser/Seller (circle one or both) was misspelled on the Assignment of Title.
The name is spelled correctly on the application.
(Person making statement must sign in signature area below.)
6. I state that _________________________________________________ and
_________________________________________________ are one and the same person.
(Person making statement must sign in signature area below.)
7. My name was entered in error as the Lienholder on the title document(s).
I do not hold any interest or lien on this vehicle.
(Person making statement must sign in signature area below.)
NOTE: THIS AFFIRMATION CANNOT BE USED FOR ODOMETER DISCLOSURE OR CORRECTIONS.
Under penalties of perjury, the undersigned states that the above statements are true and correct and will assume all
liability and costs for any litigation that may arise from the issuance of this Certificate of Title.
Printed on recycled paper. Printed by authority of the State of Illinois. September 2012 — 75M — VSD 393.8
Changes are necessary to documents that have been completed incorrectly for the following vehicle:
_____________ ________________________ _____________________________________ _______________
Year Make VIN Plate #
Signatures
______________________________________________ ______________________________________________
Signature of Seller Signature of Buyer
______________________________________________ ______________________________________________
Signature of Co-Seller Signature of Co-Buyer
______________________________________________ ______________________________________________
Date Date
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