VOLUNTARY SURRENDER OF MOTOR VEHICLE DESCRIPTION …

VOLUNTARY SURRENDER OF MOTOR VEHICLE

DESCRIPTION OF VEHICLE:

YEAR

MAKE

Date of Promissory Note:

________________________

VIN NUMBER

MODEL

Amount of Promissory Note $________________

Balance of Promissory Note:$________________

TO:________________________________________

Being unable to pay the balance due on the above described vehicle: Named as security

interest on a promissory note dated

In the amount of $

with a

balance of $

and realizing that the vehicle will continue to decline in value

and in order that I may benefit from its maximum obtainable value, I hereby voluntarily return to

you and surrender to you the above described motor vehicle for such disposition as you may wish

to make on the same, hereby transferring and assigning to you all of my right, title and interest in

said vehicle, provided, however, that such surrender and transfer is upon the express

understanding and condition that I am relieved from any and all further liability or responsibility

in connection with the said vehicle at the time of this surrender. You are hereby authorized and

empowered as my attorney in fact to cancel any insurance on said property and to apply any

premium refund to the above account, and to execute in my name the title certificate and other

documents to effect the transfer and disposition of the above vehicle any of the accessories or

attachments properly appertaining thereto and have not previously transferred or encumbered any

right, title or interest which I may have had in the said motor vehicle. I FURTHER

ACKNOWLEDGE THAT I HAVE CAREFULLY CHECKED THAT THE VEHICLE STATED

ABOVE IS FREE OF ALL MY PERSONAL PROPERTY.

Accepted by the

Customer Signature

BY_______________________________

Authorized Agent for Company

Witness

_____________________________

Witness

Date

__________________________

Date

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