Page 163 - CARS Standard Program

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)
Witness:
Identification used: DR. Lic. No.:
State: Exp: D Other ID; Type:
(Witnessed by)
(Date)
No.
(Date)
am/pm (Time)
N