Affidavit of Driver Non Owner of Vehicle

This affidavit is to be executed by an affiant deposing that he or she is not the registered owner of said vehicle and that discloses true owner of the vehicle. This affidavit must be filled out completely and must be notarized.

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AFFIDAVIT MUST BE COMPLETED IN FULL AND NOTARIZED
STATE OF MINNESOTA DISTRICT COURT
COUNTY OF HENNEPIN FOURTH JUDICIAL DISTRICT
AFFIDAVIT
DRIVER – NON OWNER OF VEHICLE
I, ____________________________ , received Citation No. ____________________
On _____________________ (date) charging no proof of insurance under M.S.
169.791. I further state that I am not the registered owner of said vehicle and that the
true owner of the vehicle is:
____________________________________
(name)
____________________________________
(address)
____________________________________
(city/state/zip)
This affidavit is made pursuant to MS 169.791. I understand that any false information
given may result in my being charged with a misdemeanor.
____________________________________
(Signature)
____________________________________
(Telephone No.)
Subscribed and sworn to before me
On _________________ , ________
(Month and day) (Year)
____________________________________________________________________________
Court Deputy or Notary Public
AFFIDAVIT MUST BE FILLED OUT COMPLETELY AND NOTARIZED