Fillable Inventory of Component Parts Purchased/ Affidavit Bill of

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Inventory of Component Parts Purchased/ Affidavit Bill of

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Inventory of Component Parts Purchased/
Affidavit Bill of Sale
Seller Information
First Name (or Entity Name)
Middle Name
Last Name
Suffix (if any)
Address
City
State
Zip
Driver License State and Number
Age
License Plate State and Number of Delivery Vehicle
Date of Purchase or Delivery
Federal Taxpayer Identification Number (or Dealer License Number, if applicable)
Purchasing Dealer Information
Name of Dealer Dealer License Number
Address
City
State
Zip
Component Part Information
Part 1
Vehicle Identification Number (if available)
Make
Model
Name/Description of Component Part
Size
Type of Material (if applicable)
Part 2
Vehicle Identification Number (if available)
Make
Model
Name/Description of Component Part
Size
Type of Material (if applicable)
Part 3
Vehicle Identification Number (if available)
Make
Model
Name/Description of Component Part
Size
Type of Material (if applicable)
Part 4
Vehicle Identification Number (if available)
Make
Model
Name/Description of Component Part
Size
Type of Material (if applicable)
Certification – State law makes falsifying information a third degree felony
I certify all component part(s) were purchased by the purchaser from the seller on the date as shown above.
Signature of Seller/Seller’s Agent
Printed Name (Same as Signature)
Date
Signature of Dealer or Authorized Agent
Printed Name (Same as Signature)
Date
Affidavit Bill of Sale – if applicable
I affirm the component part(s) listed above do not have a vehicle identification number associated with them, or the vehicle identification number
of the vehicle from which the component part was removed is not available.
Signature of Dealer or Authorized Agent
Printed Name (Same as Signature)
Date
NOTARY
STAMP
HERE
Before me, a notary public, on this day personally appeared
,
known to me to be the person whose name is subscribed on this document, and being by me first duly
sworn, declared that the statements herein contained are true and correct.
State of Texas, County of
Notary Public’s Signature
Date
VTR-207 Rev 05/20 Form available online at www.TxDMV.gov Page 1 of 1
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Inventory of Component Parts Purchased Affidavit Bill of

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Completed 9 June 2021

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