40-11-19.5. Form for disclaimer of motor vehicle ownership interest.

DISCLAIMER OF MOTOR VEHICLE OWNERSHIP INTEREST

Georgia, County

I, (name of motor vehicle owner) do hereby swear that I disclaim any and all ownership interest in:

(motor vehicle year, model, and make)

(vehicle identification number (VIN))

(vehicle registration number, if available)

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 of the Official Code of Georgia Annotated, “The Abandoned Motor Vehicle Act.” Owner signature

Sworn to and subscribed in County, Georgia, This (date)

Before me:

(Notary public signature, seal, and commission expiration date).

If you wish to disclaim ownership, return this completed and notarized form to (name and address of party owed fees).