Page 1 of 1 Affidavit of Non-Ownership Registration/InsuraneR 12/17/2020AFDV

IN THE COUNTY COURT FOR THE SIXTH JUDICIAL CIRCUIT IN AND FOR PASCO COUNTY, FLORIDA

STATE OF FLORIDA vs.

CITATION:

CASE:

AFFIDAVIT OF NON-OWNERSHIP REGISTRATION / INSURANCE

I, the undersigned, do hereby swear or affirm that under the penalty of perjury and possible contempt of court, that having been charged with:

No insurance

No tag/registration on the following vehicle:

Year: Make: Model: Color:

Do not have the required proof as required by statute and that I am unable to obtain this proof due to the following reason:

The car/truck/motorcycle has been sold.

The car/truck/motorcycle has been junked.

I just purchased the car/truck/motorcycle and cannot obtain the title from the individual until the lien is paid off.

The car/truck/motorcycle does not belong to me and I am unable to obtain the required proof from the owner.

Other:

Defendant: Date: Signature

Sworn to and subscribed before me this day of , 20 .

By: ______________________________ Deputy Clerk

Office of Nikki Alvarez-Sowles, Esq. Pasco County Clerk & Comptroller

AFFIDAVIT ACKNOWLEDGMENT The foregoing instrument was acknowledged before me this day of , 20 . by personally known to me (or who has produced as identification) and

who did did not take an oath.

NOTARY PUBLIC-STATE OF FLORIDA My commission expires: Commission No.:

who appeared to me by physical presence by means of audio-video communication technology and