STATEMENT OF FACTS (General)
ANN HARRIS BENNETT
Tax Assessor-Collector & Voter Register
State of Texas ? County of Harris ?
STATEMENT OF FACTS (General)
I, the undersigned, hereby certify that:
Vehicle Information:
Year
Make
Vin #
Correct Date of Sale:
Buyer's Name and Address:
Reason for Statement of Fact:
Other:
Signature
Date of Statement
Printed Name (same as signature)
Phone Number
Name of Company, if signing as agent thereof
Please Note: Transportation Code 501.155: FALSE NAME, FALSE INFORMATION, AND FORGERY. (a) A person commits an offense if the person knowingly provides false or incorrect information or without legal authority signs the name of another person (b) An offense under this section is a felony of the third degree.
MV-001-A
Rev. 12/14 v.4
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