CERTIFICATE OF REPOSSESSION SECURITY INTEREST A Public Service Agency

A Public Service Agency
CERTIFICATE OF REPOSSESSION
CONDITIONAL SALE CONTRACT
VEHICLE LICENSE NO. OR VESSEL CF NO.
LICENSE EXP. DATE
VEHICLE OR HULL IDENTIFICATION NO.
MAKE OF VEHICLE OR VESSEL BUILDER
NAME OF PERSON COMPLETING CERTIFICATION
TITLE OF PERSON COMPLETING CERTIFICATION
REPRESENTING (NAME OF BANK, COMPANY, ETC.)
ADDRESS
CITY
STATE
ZIP
does hereby certify:
That said ________________________________ is the legal owner within the meaning of the Vehicle Code of the above
BANK, COMPANY, ETC.
described vehicle or vessel, and that as allowed under conditional sale contract dated ____________________________
CHECK ONE
_________________________________________________________
repossessed
BANK, COMPANY, ETC.
authorized repossession of
the above described vehicle or vessel on __________________________ from ________________________________
DATE
whose post office address is/was: _____________________________________________________________________
for the following reasons: ____________________________________________________________________________
Possession of the vehicle or vessel taken at _____________________________________________________________
ADDRESS
Title and interest transferred
with
CITY
STATE
ZIP
without recourse to:
________________________________________________________________ on ____________________________
NAME
DATE
_________________________________________________________________________________________________
ADDRESS
CITY
STATE
ZIP
OR
Vehicle or vessel was sold through auto auction ____________________________________ _____________________
NAME OF AUTO AUCTION
DEALER NO.
on________________________________ at ____________________________________________________________
DATE
ADDRESS
CITY
STATE
ZIP
OR
Sold at private sale to _______________________________________________________________________________
NAME
_________________________________________________________________ on ____________________________
ADDRESS
CITY
STATE
ZIP
DATE
I certify that at least fifteen (15) days written notice of intent [twenty (20) days if place of deposit in the mail or place of address
is other than California] to sell this repossessed vehicle or vessel was given by mail to all persons liable under the contract
as required by Civil Code Section 2983.2 and that no payment was made or received as therein provided prior to the sale.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
DATE
SIGNATURE
ADDRESS
CITY
STATE
ZIP
DAYTIME TELEPHONE NO.
(
)
NOTE: Odometer disclosure for vehicle is required on complying title or separate statement.
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SIDE B
REG 119 (REV. 11/2007) WWW