TEXAS LEMON LAW REACQUIRED VEHICLE DISCLOSURE STATEMENT

Transcription

1 Form 1969 (Rev. 1/2014) TEXAS LEMON LAW REACQUIRED VEHICLE DISCLOSURE STATEMENT YEAR MAKE MODEL VIN MILEAGE_ THE MANUFACTURER/DISTRIBUTOR/CONVERTER REACQUIRED THE ABOVE VEHICLE PURSUANT TO: AN ORDER OF THE TEXAS BOARD OF THE TEXAS DEPARTMENT OF MOTOR VEHICLES A WARRANTY CLAIM OR LEMON LAW OF_ (specify state) OTHER: DEFECTS COMPLAINED OF BY THE ORIGINAL OWNER OR LESSEE: LIST REPAIRS MADE TO DEFECTS: RETAIL BUYER S INITIALS Part I: SIGNATURE OF REPRESENTATIVE OF MANUFACTURER/DISTRIBUTOR/CONVERTER PRINTED NAME OF REPRESENTATIVE, TITLE AND COMPANY Part II: SIGNATURE OF AUCTION OFFICIAL PRINTED NAME OF AUCTION AND OFFICIAL Part III: THE UNDERSIGNED DEALER CERTIFIES (1) THAT A COPY OF THIS DISCLOSURE STATEMENT WILL BE PROVIDED TO THE PURCHASER OF THIS VEHICLE, (2) THAT A DEPARTMENT APPROVED DISCLOSURE LABEL WAS AFFIXED TO AN APPROVED LOCATION ON THE VEHICLE PRIOR TO THE FIRST RETAIL SALE, AND (3) THAT BOTH THE DISCLOSURE STATEMENT AND LABEL WILL ACCOMPANY THE VEHICLE THROUGH THE FIRST RETAIL PURCHASE. SIGNATURE OF DEALER REPRESENTATIVE TITLE PRINTED NAME OF DEALERSHIP/COMPANY/REPRESENTATIVE Part IV: I ACKNOWLEDGE THAT I WAS INFORMED THAT THE MANUFACTURER, DISTRIBUTOR OR CONVERTER REACQUIRED THIS VEHICLE AS INDICATED ABOVE WITH THE DEFECTS NOTED AND THAT A COPY OF THIS DISCLOSURE STATEMENT WAS GIVEN TO ME AT THE TIME OF PURCHASE. ACKNOWLEDGEMENT OF RETAIL BUYER PRINTED NAME OF RETAIL BUYER FOR MORE INFORMATION, CALL 1-888/ OR 512/ OR VISIT WARNING: Texas Transportation Code provides that falsifying information on any required document to transfer ownership of a motor vehicle is a felony of the third degree. WHITE-RETAIL BUYER GREEN-TXDMV YELLOW-SELLING DEALER PINK-OPTIONAL USE (AUCTION/WHOLESALE BUYER) GOLDENROD-MANUFACTURER

2 NOTE: A REMARK WILL BE PLACED ON THIS VEHICLE RECORD AND THE TITLE WILL BE BRANDED TO INDICATE THE VEHICLE WAS REACQUIRED TO RESOLVE A LEMON LAW COMPLAINT OR A WARRANTY CLAIM.

3 Form 1969 (Rev. 1/2014) TEXAS LEMON LAW REACQUIRED VEHICLE DISCLOSURE STATEMENT YEAR MAKE MODEL VIN MILEAGE_ THE MANUFACTURER/DISTRIBUTOR/CONVERTER REACQUIRED THE ABOVE VEHICLE PURSUANT TO: AN ORDER OF THE TEXAS BOARD OF THE TEXAS DEPARTMENT OF MOTOR VEHICLES A WARRANTY CLAIM OR LEMON LAW OF_ (specify state) OTHER: DEFECTS COMPLAINED OF BY THE ORIGINAL OWNER OR LESSEE: LIST REPAIRS MADE TO DEFECTS: RETAIL BUYER S INITIALS Part I: SIGNATURE OF REPRESENTATIVE OF MANUFACTURER/DISTRIBUTOR/CONVERTER PRINTED NAME OF REPRESENTATIVE, TITLE AND COMPANY Part II: SIGNATURE OF AUCTION OFFICIAL PRINTED NAME OF AUCTION AND OFFICIAL Part III: THE UNDERSIGNED DEALER CERTIFIES (1) THAT A COPY OF THIS DISCLOSURE STATEMENT WILL BE PROVIDED TO THE PURCHASER OF THIS VEHICLE, (2) THAT A DEPARTMENT APPROVED DISCLOSURE LABEL WAS AFFIXED TO AN APPROVED LOCATION ON THE VEHICLE PRIOR TO THE FIRST RETAIL SALE, AND (3) THAT BOTH THE DISCLOSURE STATEMENT AND LABEL WILL ACCOMPANY THE VEHICLE THROUGH THE FIRST RETAIL PURCHASE. SIGNATURE OF DEALER REPRESENTATIVE TITLE PRINTED NAME OF DEALERSHIP/COMPANY/REPRESENTATIVE Part IV: I ACKNOWLEDGE THAT I WAS INFORMED THAT THE MANUFACTURER, DISTRIBUTOR OR CONVERTER REACQUIRED THIS VEHICLE AS INDICATED ABOVE WITH THE DEFECTS NOTED AND THAT A COPY OF THIS DISCLOSURE STATEMENT WAS GIVEN TO ME AT THE TIME OF PURCHASE. ACKNOWLEDGEMENT OF RETAIL BUYER PRINTED NAME OF RETAIL BUYER FOR MORE INFORMATION, CALL 1-888/ OR 512/ OR VISIT WARNING: Texas Transportation Code provides that falsifying information on any required document to transfer ownership of a motor vehicle is a felony of the third degree. WHITE-RETAIL BUYER GREEN-TXDMV YELLOW-SELLING DEALER PINK-OPTIONAL USE (AUCTION/WHOLESALE BUYER) GOLDENROD-MANUFACTURER

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5 Form 1969 (Rev. 1/2014) TEXAS LEMON LAW REACQUIRED VEHICLE DISCLOSURE STATEMENT YEAR MAKE MODEL VIN MILEAGE_ THE MANUFACTURER/DISTRIBUTOR/CONVERTER REACQUIRED THE ABOVE VEHICLE PURSUANT TO: AN ORDER OF THE TEXAS BOARD OF THE TEXAS DEPARTMENT OF MOTOR VEHICLES A WARRANTY CLAIM OR LEMON LAW OF_ (specify state) OTHER: DEFECTS COMPLAINED OF BY THE ORIGINAL OWNER OR LESSEE: LIST REPAIRS MADE TO DEFECTS: RETAIL BUYER S INITIALS Part I: SIGNATURE OF REPRESENTATIVE OF MANUFACTURER/DISTRIBUTOR/CONVERTER PRINTED NAME OF REPRESENTATIVE, TITLE AND COMPANY Part II: SIGNATURE OF AUCTION OFFICIAL PRINTED NAME OF AUCTION AND OFFICIAL Part III: THE UNDERSIGNED DEALER CERTIFIES (1) THAT A COPY OF THIS DISCLOSURE STATEMENT WILL BE PROVIDED TO THE PURCHASER OF THIS VEHICLE, (2) THAT A DEPARTMENT APPROVED DISCLOSURE LABEL WAS AFFIXED TO AN APPROVED LOCATION ON THE VEHICLE PRIOR TO THE FIRST RETAIL SALE, AND (3) THAT BOTH THE DISCLOSURE STATEMENT AND LABEL WILL ACCOMPANY THE VEHICLE THROUGH THE FIRST RETAIL PURCHASE. SIGNATURE OF DEALER REPRESENTATIVE TITLE PRINTED NAME OF DEALERSHIP/COMPANY/REPRESENTATIVE Part IV: I ACKNOWLEDGE THAT I WAS INFORMED THAT THE MANUFACTURER, DISTRIBUTOR OR CONVERTER REACQUIRED THIS VEHICLE AS INDICATED ABOVE WITH THE DEFECTS NOTED AND THAT A COPY OF THIS DISCLOSURE STATEMENT WAS GIVEN TO ME AT THE TIME OF PURCHASE. ACKNOWLEDGEMENT OF RETAIL BUYER PRINTED NAME OF RETAIL BUYER FOR MORE INFORMATION, CALL 1-888/ OR 512/ OR VISIT WARNING: Texas Transportation Code provides that falsifying information on any required document to transfer ownership of a motor vehicle is a felony of the third degree. WHITE-RETAIL BUYER GREEN-TXDMV YELLOW-SELLING DEALER PINK-OPTIONAL USE (AUCTION/WHOLESALE BUYER) GOLDENROD-MANUFACTURER

6 NOTE: THE SELLING DEALER IS REQUIRED TO RETURN THE COMPLETED FORM AND LABEL WITHIN 60 DAYS OF THE RETAIL SALE OF THE VEHICLE TO TEXAS DEPARTMENT OF MOTOR VEHICLES, ENFORCEMENT DIVISION, 4000 JACKSON AVE., AUSTIN, TX NOTE: THE DISCLOSURE STATEMENT AND LABEL REQUIREMENT ALSO APPLY TO VEHICLES REACQUIRED IN ANOTHER STATE AND TRANSFERRED TO TEXAS FOR RESALE.

7 Form 1969 (Rev. 1/2014) TEXAS LEMON LAW REACQUIRED VEHICLE DISCLOSURE STATEMENT YEAR MAKE MODEL VIN MILEAGE_ THE MANUFACTURER/DISTRIBUTOR/CONVERTER REACQUIRED THE ABOVE VEHICLE PURSUANT TO: AN ORDER OF THE TEXAS BOARD OF THE TEXAS DEPARTMENT OF MOTOR VEHICLES A WARRANTY CLAIM OR LEMON LAW OF_ (specify state) OTHER: DEFECTS COMPLAINED OF BY THE ORIGINAL OWNER OR LESSEE: LIST REPAIRS MADE TO DEFECTS: RETAIL BUYER S INITIALS Part I: SIGNATURE OF REPRESENTATIVE OF MANUFACTURER/DISTRIBUTOR/CONVERTER PRINTED NAME OF REPRESENTATIVE, TITLE AND COMPANY Part II: SIGNATURE OF AUCTION OFFICIAL PRINTED NAME OF AUCTION AND OFFICIAL Part III: THE UNDERSIGNED DEALER CERTIFIES (1) THAT A COPY OF THIS DISCLOSURE STATEMENT WILL BE PROVIDED TO THE PURCHASER OF THIS VEHICLE, (2) THAT A DEPARTMENT APPROVED DISCLOSURE LABEL WAS AFFIXED TO AN APPROVED LOCATION ON THE VEHICLE PRIOR TO THE FIRST RETAIL SALE, AND (3) THAT BOTH THE DISCLOSURE STATEMENT AND LABEL WILL ACCOMPANY THE VEHICLE THROUGH THE FIRST RETAIL PURCHASE. SIGNATURE OF DEALER REPRESENTATIVE TITLE PRINTED NAME OF DEALERSHIP/COMPANY/REPRESENTATIVE Part IV: I ACKNOWLEDGE THAT I WAS INFORMED THAT THE MANUFACTURER, DISTRIBUTOR OR CONVERTER REACQUIRED THIS VEHICLE AS INDICATED ABOVE WITH THE DEFECTS NOTED AND THAT A COPY OF THIS DISCLOSURE STATEMENT WAS GIVEN TO ME AT THE TIME OF PURCHASE. ACKNOWLEDGEMENT OF RETAIL BUYER PRINTED NAME OF RETAIL BUYER FOR MORE INFORMATION, CALL 1-888/ OR 512/ OR VISIT WARNING: Texas Transportation Code provides that falsifying information on any required document to transfer ownership of a motor vehicle is a felony of the third degree. WHITE-RETAIL BUYER GREEN-TXDMV YELLOW-SELLING DEALER PINK-OPTIONAL USE (AUCTION/WHOLESALE BUYER) GOLDENROD-MANUFACTURER

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9 Form 1969 (Rev. 1/2014) TEXAS LEMON LAW REACQUIRED VEHICLE DISCLOSURE STATEMENT YEAR MAKE MODEL VIN MILEAGE_ THE MANUFACTURER/DISTRIBUTOR/CONVERTER REACQUIRED THE ABOVE VEHICLE PURSUANT TO: AN ORDER OF THE TEXAS BOARD OF THE TEXAS DEPARTMENT OF MOTOR VEHICLES A WARRANTY CLAIM OR LEMON LAW OF_ (specify state) OTHER: DEFECTS COMPLAINED OF BY THE ORIGINAL OWNER OR LESSEE: LIST REPAIRS MADE TO DEFECTS: RETAIL BUYER S INITIALS Part I: SIGNATURE OF REPRESENTATIVE OF MANUFACTURER/DISTRIBUTOR/CONVERTER PRINTED NAME OF REPRESENTATIVE, TITLE AND COMPANY Part II: SIGNATURE OF AUCTION OFFICIAL PRINTED NAME OF AUCTION AND OFFICIAL Part III: THE UNDERSIGNED DEALER CERTIFIES (1) THAT A COPY OF THIS DISCLOSURE STATEMENT WILL BE PROVIDED TO THE PURCHASER OF THIS VEHICLE, (2) THAT A DEPARTMENT APPROVED DISCLOSURE LABEL WAS AFFIXED TO AN APPROVED LOCATION ON THE VEHICLE PRIOR TO THE FIRST RETAIL SALE, AND (3) THAT BOTH THE DISCLOSURE STATEMENT AND LABEL WILL ACCOMPANY THE VEHICLE THROUGH THE FIRST RETAIL PURCHASE. SIGNATURE OF DEALER REPRESENTATIVE TITLE PRINTED NAME OF DEALERSHIP/COMPANY/REPRESENTATIVE Part IV: I ACKNOWLEDGE THAT I WAS INFORMED THAT THE MANUFACTURER, DISTRIBUTOR OR CONVERTER REACQUIRED THIS VEHICLE AS INDICATED ABOVE WITH THE DEFECTS NOTED AND THAT A COPY OF THIS DISCLOSURE STATEMENT WAS GIVEN TO ME AT THE TIME OF PURCHASE. ACKNOWLEDGEMENT OF RETAIL BUYER PRINTED NAME OF RETAIL BUYER FOR MORE INFORMATION, CALL 1-888/ OR 512/ OR VISIT WARNING: Texas Transportation Code provides that falsifying information on any required document to transfer ownership of a motor vehicle is a felony of the third degree. WHITE-RETAIL BUYER GREEN-TXDMV YELLOW-SELLING DEALER PINK-OPTIONAL USE (AUCTION/WHOLESALE BUYER) GOLDENROD-MANUFACTURER

10 NOTE: THE MANUFACTURER IS REQUIRED TO (1) AFFIX A DISCLOSURE LABEL TO THE VEHICLE PROVIDED BY OR APPROVED BY THE DEPARTMENT; (2) PROVIDE THE DEPARTMENT UPON TRANSFER OF THE VEHICLE, IN WRITING, THE NAME, ADDRESS AND TELE OF THE TRANSFEREE, REGARDLESS OF RESIDENCE, WITHIN 60 DAYS OF THE TRANSFER; AND (3) ISSUE A 12 MONTH/12,000 MILE BASIC WARRANTY ON THE VEHICLE, EXCEPT FOR NON-OEM ITEMS. NOTE: THE DISCLOSURE STATEMENT AND LABEL REQUIREMENT ALSO APPLY TO VEHICLES REACQUIRED IN ANOTHER STATE AND TRANSFERRED TO TEXAS FOR RESALE.