Tennessee Affidavit Form
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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 ______________________________________