Iowa Affidavit of Correction Form

AFFIDAVIT OF CORRECTION

Form 411219 (06-04)

Please read all instructions before completing this form. This form may be accepted to correct information that has been written in error on a title, application for title, damage disclosure statement, or other document required for title transfer or when these documents contain an alteration or erasure. This affidavit cannot be used for odometer certification errors.

1. This affidavit can only be used to correct the errors identified. 2. All signatories to the original error, erasure, or alteration must sign this affidavit. 3. This affidavit must be completed in full, notarized, and attached to the document that contains the error to be corrected. 4. Facsimiles and photocopies are not acceptable. Vehicle Description Make

Year

VIN

Title or MCO# Description of Error, Erasure, or Alteration The sale date of

was entered in error. The correct sale date is:

The seller signed his/her name in the incorrect space on the The buyer signed his/her name in the incorrect space on the Signatures Under penalty of perjury, the undersigned states that the above statements are true and correct and will warrant and defend the title of any person to the described vehicle insofar as the claim rests upon the title issued by virtue of this affidavit. The undersigned will protect and hold harmless the county treasurer or Department of Transportation from any damages that might arise from the issuance of such title.

Date

Signature

Title (Buyer, seller, etc.)

Date

Signature

Title (Buyer, seller, etc.)

Date

Signature

Title (Buyer, seller, etc.)

Subscribed and sworn to before me this

day of

,

(Seal) Notary Public