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Get Il Vsd-252.4 2010

Print Jesse White Secretary of State Reset AFFIRMATION NON-RECEIPT OF TITLE Date Year Name of Owner s 1 2 Street and No. of R.F.D. City State ZIP Code DOES HEREBY AFFIRM THAT HIS/HER/THEIR VEHICLE Vehicle Identification Number Make Model Body Style WAS PURCHASED ON. THE TITLE HAS NEVER BEEN RECEIVED FROM THE SECRETARY OF STATE EVEN THOUGH THEIR RECORDS DO INDICATE THAT THE TITLE WAS MAILED. I/We hereby affirm that the information provided is true and correct. Signature of Owner s 1 Printed by authority of the State of Illinois. City State ZIP Code DOES HEREBY AFFIRM THAT HIS/HER/THEIR VEHICLE Vehicle Identification Number Make Model Body Style WAS PURCHASED ON. THE TITLE HAS NEVER BEEN RECEIVED FROM THE SECRETARY OF STATE EVEN THOUGH THEIR RECORDS DO INDICATE THAT THE TITLE WAS MAILED. THE TITLE HAS NEVER BEEN RECEIVED FROM THE SECRETARY OF STATE EVEN THOUGH THEIR RECORDS DO INDICATE THAT THE TITLE WAS MAILED. I/We hereby affirm that the information provided is true and correct. Signature of Owner s 1 Printed by authority of the State of Illinois. City State ZIP Code DOES HEREBY AFFIRM THAT HIS/HER/THEIR VEHICLE Vehicle Identification Number Make Model Body Style WAS PURCHASED ON. THE TITLE HAS NEVER BEEN RECEIVED FROM THE SECRETARY OF STATE EVEN THOUGH THEIR RECORDS DO INDICATE THAT THE TITLE WAS MAILED. I/We hereby affirm that the information provided is true and correct. Signature of Owner s 1 Printed by authority of the State of Illinois. .

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