Repossessed from Owner (Borrower) Name: ____________________________________________________________________________
Address ________________________________________________________________________________________________
City/State______________________________________________________________________ ZIP Code ____________________
Creditor (Lienholder) Name: ________________________________________________________________________________________
Address ________________________________________________________________________________________________
City/State______________________________________________________________________ ZIP Code ____________________
Purchaser(s) Name: ______________________________________________________________________________________________
Address ________________________________________________________________________________________________
City/State______________________________________________________________________ ZIP Code ____________________
The owner’s vehicle was lawfully repossessed by the lienholder for default under the terms of the owner’s loan/security agreement with
the lienholder. The lienholder lawfully terminated the owner’s interest in the vehicle pursuant to the terms of the loan/security agreement.
The lienholder delivered or mailed to the owner at the owner’s last known address and any other lienholder of record the Notice of
Redemption required under the Illinois Vehicle Code (625 ILCS 5/3-114(f-5)(1)), and the sale of the vehicle occurred after the expiration
of 21 days from the date of mailing or delivery of the Notice. If the owner’s vehicle was a non-commercial vehicle, the lienholder also
delivered or mailed to the owner at the owner's last known address the Affidavit of Defense required under the Illinois Vehicle Code (625
ILCS 5/3-114(f5)(2)), and no response was received from the owner within 21 days after mailing or delivery.
Owner’s Vehicle (Collateral): Year __________ Make _______________________________Model _____________________________
VIN ____________________________________________________________ Title # ______________________________________
This space for use by
Secretary of State
Secretary of State
Affidavit of Repossession
(625 ILCS 5/3-114(f-5)(3))
Secretary of State
Vehicle Services Department
501 S. Second St.
Springfield, IL 62756
217-782-6306
www.cyberdriveillinois.com
Commercial Vehicle
Non-Commercial Vehicle
Printed by authority of the State of Illinois. June 2005 — 10M — VSD 609.3
Date of Repossession: ________________________________________
Date of Mailing or Delivery of Notice of Redemption: _________________
Date of Sale of Vehicle to Purchaser: _____________________________
Vehicle repossessed is not damaged in excess of 33 1/3%.
Vehicle repossessed is damaged in excess of 33 1/3% of its fair market
value.
Check if Certificate of Title is lost and no third party is involved in the transaction.
Under penalties of perjury, the undersigned lienholder states that the above requirements have been complied with and the undersigned
lienholder will assume all liability and costs for any litigation that may arise from the issuance of a Certificate of Title.
Notary:
Subscribed and sworn to before me this ___________________
day of ____________________________________ , _________ .
____________________________________________________
Notary Public
Lienholder:
By __________________________________________________
Signature of Lienholder’s Authorized Representative
____________________________________________________
Date
My Commission Expires: _________________________________ (Seal)
