Illinois Affidavit of Repossession Form

Use this template/form as an Affidavit of Repossession Form in the State of Illinois

illinois-affidavit-of-repossession

Text version of this Form

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Secretary of State
This space for use by
Affidavit of Repossession Secretary of State

(625 ILCS 5/3-114(f-5)(3))

Secretary of State
Vehicle Services Department
❒ Commercial Vehicle
501 S. Second St.
Springfield, IL 62756 ❒ Non-Commercial Vehicle
217-782-6306
www.cyberdriveillinois.com

Repossessed from Owner (Borrower) Name: ____________________________________________________________________________

Address ________________________________________________________________________________________________

City/State______________________________________________________________________ ZIP Code ____________________

Creditor (Lienholder) Name: ________________________________________________________________________________________

Address ________________________________________________________________________________________________

City/State______________________________________________________________________ ZIP Code ____________________

Purchaser(s) Name: ______________________________________________________________________________________________

Address ________________________________________________________________________________________________

City/State______________________________________________________________________ ZIP Code ____________________

The owner’s vehicle was lawfully repossessed by the lienholder for default under the terms of the owner’s loan/security agreement with
the lienholder. The lienholder lawfully terminated the owner’s interest in the vehicle pursuant to the terms of the loan/security agreement.

The lienholder delivered or mailed to the owner at the owner’s last known address and any other lienholder of record the Notice of
Redemption required under the Illinois Vehicle Code (625 ILCS 5/3-114(f-5)(1)), and the sale of the vehicle occurred after the expiration
of 21 days from the date of mailing or delivery of the Notice. If the owner’s vehicle was a non-commercial vehicle, the lienholder also
delivered or mailed to the owner at the owner’s last known address the Affidavit of Defense required under the Illinois Vehicle Code (625
ILCS 5/3-114(f5)(2)), and no response was received from the owner within 21 days after mailing or delivery.

Owner’s Vehicle (Collateral): Year __________ Make _______________________________Model _____________________________

VIN ____________________________________________________________ Title # ______________________________________

Date of Repossession: ________________________________________ ❒ Vehicle repossessed is not damaged in excess of 33 1/3%.

Date of Mailing or Delivery of Notice of Redemption: _________________ ❒ Vehicle repossessed is damaged in excess of 33 1/3% of its fair market
value.
Date of Sale of Vehicle to Purchaser: _____________________________

❒ Check if Certificate of Title is lost and no third party is involved in the transaction.

Under penalties of perjury, the undersigned lienholder states that the above requirements have been complied with and the undersigned
lienholder will assume all liability and costs for any litigation that may arise from the issuance of a Certificate of Title.

Notary: Lienholder:

By __________________________________________________
Subscribed and sworn to before me this ___________________ Signature of Lienholder’s Authorized Representative

day of ____________________________________ , _________ .
____________________________________________________
Date

____________________________________________________
Notary Public

My Commission Expires: _________________________________ (Seal)

Printed by authority of the State of Illinois. June 2005 — 10M — VSD 609.3