Get Mvr 92a 2012-2025

MVR-92H Rev. 09/12 AFFIDAVIT OF FACTS TO ACCOMPANY INDEMNITY BOND The following questions must be answered in detail and this form must be attached to any application for title that is supported by an Indemnity Bond. Furnish any document in your possession showing proof of ownership* Examples would be a Title Bill of Sale Conditional Sales Contract Invoices Out of State Registrations. Year Make Body Style Vehicle Identification Number 1. How did you acquire the vehicle List the seller s full name full address and phone number. 2. List the date you acquired the vehicle. 3. Is the vehicle currently titled in North Carolina If no list the last title state. 4. Does the VIN plate appear on the vehicle If so please give the location* 5. Are there any liens outstanding on the vehicle If so list the lienholder s name and provide a lien release. 6. Has the vehicle been wrecked If so list the major parts replaced* 7. If you were given a title at the time of purchase why can it not be furnished at the present time 8. Explain in detail why the seller did not give you a properly assigned title for the vehicle. 9. What steps have you taken to contact the seller/previous owner to obtain proper ownership documentation I we certify that the above information is correct to the best of my knowledge. OWNER S SIGNATURE Date County State she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated* NAME S OF PRINCIPALS S Notary Notary Printed Signature or Typed Name SEAL My Commission Expires. Furnish any document in your possession showing proof of ownership* Examples would be a Title Bill of Sale Conditional Sales Contract Invoices Out of State Registrations. Year Make Body Style Vehicle Identification Number 1. How did you acquire the vehicle List the seller s full name full address and phone number. Year Make Body Style Vehicle Identification Number 1. How did you acquire the vehicle List the seller s full name full address and phone number. 2. List the date you acquired the vehicle. 3. Is the vehicle currently titled in North Carolina If no list the last title state. 2. List the date you acquired the vehicle. 3. Is the vehicle currently titled in North Carolina If no list the last title state. 4. Does the VIN plate appear on the vehicle If so please give the location* 5. Are there any liens outstanding on the vehicle If so list the lienholder s name and provide a lien release. 4. Does the VIN plate appear on the vehicle If so please give the location* 5. Are there any liens outstanding on the vehicle If so list the lienholder s name and provide a lien release. 6. Has the vehicle been wrecked If so list the major parts replaced* 7. If you were given a title at the time of purchase why can it not be furnished at the present time 8. 6. Has the vehicle been wrecked If so list the major parts replaced* 7. If you were given a title at the time of purchase why can it not be furnished at the present time 8. Explain in detail why the seller did not give you a properly assigned title for the vehicle. 9. What steps have you taken to contact the seller/previous owner to obtain proper ownership documentation I we certify that the above information is correct to the best of my knowledge. .