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Affidavit of Fact
The following described vehicle:
Erasure or Alteration was made due to:
VIN #:
Seller:
Purchaser:
Typographical Error
Customer changed mind, did not take possession
Purchaser's name misspelled
Correct Date of Sale to
Correct Odometer to
Other, Explain:
Seller(s)'s Signature Purchaser(s)'s Signature
Date Date
400 N. San Jacinto St. Conroe, Texas 77301
(936) 539-7897 (281) 354-5511 ext 7897
Tammy J. McRae Tax Assessor-Collector Montgomery County
Rev
10/
14
