Free affidavit form 21
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Tennessee Department of Revenue
Vehicle Services Division


44 Vantage Way, Suite 160
Nashville, TN 37243-8050

County of ______________________________________________ Date ___________________________
Under penalties of perjury, the undersigned, duly sworn, deposes and says that the owner of the motor
vehicle described as:
Make _________________________ VIN _________________________________________________
Model __________________ Body ______________________ Yr. Model ____________________
died on the _______________________ day of ________________________ in ____________________
County of ____________________________________________________, Tennessee. That the deceased,
___________________________________________________________________________, left no estate
Name of Deceased
necessitating administration and no letters testamentary or of administration have been issued to any
person. There are no debts or encumbrances remaining unpaid, which are