Fillable Form 1.: Affidavit Regarding Due Diligence MINNESOTA DEPARTMENT

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Form 1.: Affidavit Regarding Due Diligence MINNESOTA DEPARTMENT

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MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
445 Minnesota Street
Saint Paul, MN 55101-5197
Phone: (651) 296-2605 TTY/TDD: (651) 282-6555
Web: dvs.dps.mn.gov
Affidavit Regarding Due Diligence
Use this form when your vehicle is six model years or older and it cannot be titled or registered because you do not have the required title documents,
pursuant to Minn. Stat. § 168A.07 (Laws 2012, ch.287).
INSTRUCTIONS:
1.
2.
3.
Print or type to complete this form: Affidavit Regarding Due Diligence (PS2026).
The form and additional documents noted below must be submitted at a Deputy Registrar office. To determine the amount due and to find
the office nearest to you, visit dvs.dps.mn.gov
or call 651-297-2126. Do not mail in the form.
When this form is submitted, the Deputy Registrar will provide a bond form (PS2052) to be completed by customer and surety company.
NOTE: You must provide evidence of this valuation, such as a printout of the NADA or Blue Book price guide or other documentation. Picture(s)
should clearly show all sides of the vehicle. The Deputy Registrar will provide a bond document in the form and amount (1.5 times the value of the
vehicle as determined by the department) as provided in MS 168.07, subd. 1b.
I (full name of applicant) being sworn/affirmed on oath state:
Model Year
Vehicle Identification Number
VEHICLE DESCRIPTION
Make
Evidence of this and pictures of the vehicle are attached.
The vehicle is six model years or older (current calendar year - vehicle model year = six or more);
I have attached a completed Application for Title, and all required taxes and fees have been paid;
I am an owner of the vehicle; and
I have physical possession of the vehicle.
In attempting to transfer interest in the vehicle or obtain a certificate of title or lien release, I was unable
after using due diligence to (check one):
(A) Determine the names or locations of one or more owners, prior owners, or lienholders; OR
(B) Successfully contact one or more owners, prior owners, or lienholders known to me.
The fair market value of this vehicle is $
I purchased the vehicle from:
Name of seller
Address of seller
Model Type Plate Number
Verification and Acknowledgement
I swear/affirm under oath, that the statements set forth herein are true and correct to the best of my knowledge and belief.
PS2026-01 (07/12)
Printed or Type Name of Petitioner (Applicant)
Signed and attested before me on _____________________________ (date)
Notary Signature
X
Signature of Petitioner (Applicant)
X
County State My Commission Expires
Notary Stamp
-over-
Date of Sale
Print Form
STATE OF MINNESOTA
DEPARTMENT OF PUBLIC SAFETY
DIVISION OF MOTOR VEHICLES
OWNERSHIP AND SECURITY
INTEREST SURETY BOND
MUST BE BONDED FOR 3 YEARS AT $
.00
Applicant Name
Address
City, State, Zip
KNOW ALL MEN BY THESE PRESENTS, That We, as principal, and
as surety are held and firmly bound to the State of Minnesota in the amount of
.00 DOLLARS, For the payment of this well and truly to be made we jointly by these presents.
The condition of this obligation is such that whereas the principal has made application to the Registrar of Motor Vehicles for Minnesota
Certificate of Title to a vehicle described in the application for title as,
Vehicle Identification Number
Body Type
Make
Model Year
which application was filed with Registrar, pursuant to Laws, Chapter 168A.07 on
(Application Date)
, and the principal is
unable to provide proof of ownership of the vehicle or that the vehicle was previously registered and in a jurisdiction where the security
interest need not be listed on the Certificate of Title to be perfected in the foreign jurisdiction, or the vehicle was previously registered
in a non-title state. The Registrar has determined the above mentioned vehicle is valued at $ .00.
NOW, THEREFORE, the condition of this bond is to indemnity any prior owner and secured party and any subsequent purchaser of
the vehicle or person acquiring any security interest therein, or the successor in interest of any said person, against any expense, loss,
or damage, including reasonable attorney' fees, by reason of the issuance of the Certificate of Title to the vehicle or on account of any
defect in an undisclosed security interest upon the right, title and interest of the applicant in and to the vehicle in an amount equal to
one and one-half times the value of the vehicle as determined by the Registrar for a period of three years or prior thereto in the event
the vehicle is no longer registered in Minnesota and the currently valid Certificate of Title is surrendered, unless the Registrar has been
notified of the pendency of an action to recover on the bond and if all questions as to ownership and outstanding security have been
resolved to the satisfaction of the Registrar. Any such interested persons shall have a right of action to recover on such bond for any
breach of its conditions, but the aggregate liability of the surety to all such persons shall in no event exceed the amount of the bond.
*Note: Bond must be executed in an amount equal to 150% of the value of the vehicle as determined by the Registrar.
IN WITNESS WHEREOF, we have duly executed the foregoing obligation
Principal
X
Surety
By
Attorney in Fact
(Corporate Seal)
(Corporate Seal of Surety)
PS2052-04 (11/12) -over-
Deputy
$
this day of 20
1.5 TIMES THE VALUE OF THE VEHICLE
PS2052A-02
INDIVIDUAL PARTNERSHIP ACKNOWLEDGMENT
STATE OF MINNESOTA
COUNTY OF
On this day of , 20 , before me personally appeared
to be known to be the person described in
and who executed the foregoing bond, and acknowledged that he executed the same as
free act and deed.
(Notarial Seal)
)
) ss
)
CORPORATE ACKNOWLEDGMENT FOR PRINCIPAL
STATE OF MINNESOTA
COUNTY OF
On this day of , 20 , before me personally appeared
and
who being by me duly sworn, did say that they are respectively and
(Notarial Seal)
)
) ss
)
, to me personally known,
, aof
corporation, that the seal affixed to the foregoing instrument is the corporate seal of the corporation, and that said instrument was
executed in behalf of the corporation by authority of its board of directors, and they acknowledged said instrument to be the free
act and deed of the corporation.
AFFIX HERE ACKNOWLEDGMENT OF CORPORATE SURETY
AND ATTACH POWER OF ATTORNEY
Approved as to form and execution
Approved and filed , 20
Commissioner of Public Safety
Full Name of Surety Co.
Home Office Address
Name of Attorney in Fact
Name of Local Agency
Address of Local Agency
If this bond is executed outside the State of Minnesota it must be countersigned by a Minnesota Resident Agent of the Surety Co.
Name of Agent affixing countersignature
Address
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Form 1.: Affidavit Regarding Due Diligence MINNESOTA DEPARTMENT

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Completed 26 February 2021

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