Page 165 - Microsoft Word - NEW 2017 Standard Program.docx

Vehicle Redemption - Debtor

Agency Name:

Date:

Case #:

Date of Repossession:

To:

Legal Owner:

Collateral:

VIN#:

By signing this receipt, I do certify that I have received the vehicle described above in the

same condition now as it was when it was repossessed.

I also do hereby release and the legal
owner named above and all principals and employees from any claims, demands and

rights of action arising out of said repossession and I understand that said repossession
was authorized by the legal owner.

(Signature) (Date)

Witness:

Identification used: DR. Lic. No.:

State: Exp:

D Other ID; Type: No.

am/pm

(Witnessed by) (Date) (Time)

N