☐ agree;

☐ do not agree;

☐ unknown;

that the Petitioner is the owner of the Vehicle.

WHEREFORE, Petitioner requests the Court to enter an order directing the Pennsylvania Department of Transportation to issue a title in Petitioner's name, provided Petitioner complies with the costs, fees, taxes and other paperwork required by the Pennsylvania Department of Transportation to accomplish this purpose.

Petitioner:

Signature

Print Name

Date: _____

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