AFFIDAVIT OF REPOSSESSION / TITLE APPLICATION
If the secured party has obtained the current certificate of title, it must be attached to this document.
If the secured party has not obtained the current certificate of title, this application serves as a combination
repossession form and the application for title.
To determine the fees due or to obtain assistance in completing this application, contact:
A DEPUTY REGISTRAR OR THE DEPARTMENT OF NATURAL RESOURCES, LICENSE CENTER
If applying by mail make remittance to: Brainerd License Office
623 NW 4th St
Brainerd, MN 56401
2188555169
Hull Identification Number
Year Make Model
Name of Registered Owner (Last, First, Middle) Registration Number
MN
Title Number
Owner Address City State Zip
I, the undersigned, on oath duly swear, depose and say that:
Name of Secured Party Date of Repossession
Address City State Zip
is the owner of the watercraft described above. The interest of the owner was lawfully terminated and disposition made pursuant to the
terms of the security agreement. The application for a Certificate of Title is based on the repossession of this watercraft.
I further state that in consideration of the issuance of the Certificate of Title applied, we hereby agree to indemnify the Department of
Natural Resources Commissioner and all persons acting for him from any and all liability which may be incurred by the issuance of such
certificate and agree, at our own expense, to defend any suit which may be brought against the Commissioner or any person acting for him
as a result of issuing this certificate.
SUBSCRIBED AND SWORN TO ME THIS
_______DAY OF _____________________, 20______
NOTARY PUBLIC, COUNTY OF:_________________
MY COMMISSION EXPIRES: ____________________
NOTARY PUBLIC SIGNATURE
New Title Number (Office Use Only)
Signature of Authorized Agent for Secured Party
