
AUTHORIZATION FOR PAYOFF OF MOTOR VEHICLE*
The undersigned hereby authorizes to do the following (check one):
a Pay off the balance due upon the following-described vehicle, which balance is $ and is due to
, who is / are hereby authorized to deliver to the bearer of
this instrument the vehicle ownership certificate, insurance policy, original contract, and / or any other document, credit, or refund held in
connection with this vehicle or its account.
a Accept, from , the sum of $ ,
that being the balance due on the following-described vehicle and, upon receipt of the balance due, to surrender to the payor the document
of title pertaining to the vehicle, properly endorsed and released. Also, cancel the insurance policy of the undersigned, and pay any
unearned insurance premium, together with any unearned interest and/or brokerage, to the company or person authorized to make the pay-
off herein described. Any rebate check should be made payable to .
The vehicle to which this instument pertains is described as follows:
YEAR MAKE BODY TYPE MODEL
VEHICLE ID# COLOR MILEAGE PLATE # AND ISSUING STATE
This instrument is not a bill of sale. However, all persons are hereby notified that the above-referenced vehicle is being sold in
“AS IS” condition. No warranty is either expressed or implied by this instrument.
IN WITNESS WHEREOF, this instrument was signed at , by the
CITY STATE
undersigned on .
DATE
SIGNATURE SIGNATURE
NAME (TYPED OR PRINTED) NAME (TYPED OR PRINTED)
DATE OF BIRTH DRIVER LICENSE # DATE OF BIRTH DRIVER LICENSE #
WITNESS WITNESS
* If acknowledgement of notary is either desired or required by law, use S-N Form No. 23 or 24. (If signature is notarized, signature of witness(es) is not required.)
FORM No. 254 – AUTHORIZATION FOR PAYOFF OF MOTOR VEHICLE. EE COPYRIGHT 2000 STEVENS-NESS LAW PUBLISHING CO., PORTLAND, OR 97204