IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
n Re: ___
Year, Make, Model
VIN
VIN
No.: ___
1. Petitioner is ___, an adult individual residing at ___, Adams County, Pennsylvania.
2. Petitioner is currently in possession of one (1) vehicle: Year: ___; Make: ___; Model: ___; Vehicle Identification Number (VIN): ___; which was acquired under the following circumstances (include date acquired and how acquired):
I am unable to obtain a Certificate of Title from the Commonwealth of Pennsylvania, Department of Transportation for the following reasons:
The individuals or entities and addresses who have an interest or assert an interest in the above property are as follows (from DL-135 Request for Vehicle Information, attached):