the Department has reasonable grounds to believe that the application contains a false or fraudulent statement;
I have failed to furnish required information or documents or any additional information the Department reasonably requires;
I have not paid at least one month’s registration tax or registered the vehicle under MS. 168.187.
7. I was told that I could obtain a title for the vehicle only if I posted a bond in the amount of $______________ .
I have posted the bond.
I have not posted the bond.
Signature (Sign only in front of notary public or court administrator.)
Sworn/affirmed before me this
Name: Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator
See Next Page for Affidavit of Mailing
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