Tennessee Affidavit Form

State of Tennessee
Department of Revenue
Vehicle Services Division
44 Vantage Way, Suite 160
Nashville, Tennessee 37243-8050
Comes the Affiant _______________________________________________________________
(Printed Name)
Under penalties of perjury who, being duly sworn, deposes and says, to wit as follows:
Further Affiant Saith Not
Signature of Affiant
State of Tennessee
County of ____________________________
On this __________________ day of ___________________, 20________, before me personally
to me known to be the person described in and who executed the foregoing instrument, and
acknowledged that he/she executed the same as his/her free act and deed, for the purposes therein
set forth.
(County Clerk)
(Notary Public)
My Commission Expires _________________________________________, 20______________
RV-F1311001 (7-12)
RDA 692