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IN THE MAGISTRATE COURT OF WALTON COUNTY, STATE OF GEORGIA Civil Action#: * Plaintiff/Lien Claimant * AFFIDAVIT OF DISPOSITION OF Vs. * ABANDONED MOTOR VEHICLE * * Motor Vehicle (list year, make, model) * Vehicle Identification Number (VIN#) Tag number (list State, if applicable) The name(s) and addresses(s) of the last known registered owner(s) &/or lienholder(s): (“Owner” means registered owner, the owner as recorded on title, lessor, lessee, security interest holder(s) & all lienholders as shown on the records of the Department of Motor Vehicle Safety); I, (hereinafter referred to as Plaintiff), personally appeared before the undersigned officer, duly authorized to administer oaths, swears/affirms the following; The vehicle was redeemed by owner/lienholder prior to public auction. No sums are due and payable. OR; The vehicle was sold at public auction: On Date of Sale Address of sale (street, city, state, zip code) Within the city limits of: Unincorporated Walton County. The sale was conducted in compliance wit the provisions of O.C.G.A. 40-11-6. 1. The vehicle was impounded at the request of a: private individual city officer/official of (Name of Municipality) county officer/official Georgia State Patrol. 2. The amount received for the vehicle at public sale: $ 3. The amount of the lien on the vehicle $ 4. Future storage at $ per (days) $ 5. The amount due to Clerk of Court and submitted herewith $ A true and correct copy of the bill of sale of the vehicle is attached hereto as Exhibit A. Plaintiff or Agent for Plaintiff Sworn to and subscribed before me this of Notary Public/Attesting Official