AFFIDAVIT OF OWNERSHIP FOR EQUIPMENT

VTR-279 (Rev. 11/09) Page 1 of 1

This is to certify that I am the legal owner of the following described equipment:

Year Model

Make

Type

I further certify that any bill of sale, invoice, Manufacturers Statement of Origin, or other evidence covering said equipment has been lost or destroyed. Therefore, this form is being executed by me as my ownership document as required by Transportation Code 501.033, in order that I may secure an identification number for the above described equipment.
Company Name (if applicable)

Signature(s) of Owner(s)/Agent

Before me this day personally appeared the affiant(s) whose signature(s) appear(s) above who by me being duly sworn upon oath says that the statements set forth above are true and correct.
Subscribed and sworn to before me this

day of

Year

Notary Public in and for

County, Texas

WARNING!

TRANSPORTATION CODE 501.155 PROVIDES THAT FALSIFYING INFORMATION ON ANY REQUIRED STATEMENT OR APPLICATION IS A THIRD-DEGREE FELONY. TEXAS DEPARTMENT OF MOTOR VEHICLES VEHICLE TITLES AND REGISTRATION DIVISION AUSTIN TX 78779-0001 INSTRUCTIONS

This affidavit may ONLY be used for vehicles that are not subject to the Transportation Code, Chapter 501, Texas Certificate of Title Act, such as a tractor, farm implement, etc. This form shall accompany an Application for Assigned or Reassigned Number (Form 68-A) for equipment when the owner does not have ownership documents for the equipment. If the equipment was seized by law enforcement, a court order awarding ownership shall be required.