MAG 40-09
Georgia, _________ County
I, ___________________ (name of motor vehicle owner) do hereby swear that I disclaim any and all ownership
interest in:
Vehicle Make: ____________________ Year: ______ Model: _______________________________
Vehicle ID # (VIN): _______________________________ Vehicle License #: __________ State ________
I understand that by signing this form I will no longer hold any rights to the above listed vehicle and such vehicle
may be sold at auction to satisfy a debt related to a lien filed against the vehicle.
I further understand that disclaiming an ownership interest in this vehicle does not relieve me of any other debts
related to such vehicle, such as a debt entered into for the purchase of such vehicle.
By signing this form, I understand that I waive all future notices to which I am entitled under Article 1A of Chapter
11 of Title 40, “The Abandoned Motor Vehicle Act.”
Sworn to and Subscribed before me
This ____ day of_____________20___
________________________________ ________________________________________
Notary Public or Clerk Owner of Vehicle
My Commission Expires:
If you wish to disclaim ownership, return this completed and notarized form to _____________________________
______________________________________________________________(name and address of party owed fees)