I. Introduction

This Affidavit of Vehicle Damage is executed by [Your Name], the affiant, to formally report and document the damage sustained by the vehicle described below. The affidavit serves as a written statement of the condition of the vehicle after sustaining damage, and it is presented to Jeremy Marvin, the notary, located at Omaha, NE 68101, for verification and acknowledgment of the information provided.

The details of the damaged vehicle are as follows:

• Vehicle Make: Ford

• Vehicle Model: F-150

• Vehicle Year: 2050

• Vehicle Identification Number (VIN): 1FTEW1C56LFA12345

• License Plate Number: ABC5789

• Odometer Reading: 45,200 miles

This affidavit is executed to document the condition of the vehicle and to serve as a formal statement for insurance, legal, or other purposes as required by the affiant.

II. Vehicle Damage Declaration

I, [Your Name], the affiant, hereby declare under oath the following information regarding the damage sustained by the vehicle described above:

• On February 15, 2050, my Ford F-150 was involved in an incident at 1234 Maple Street, Omaha, NE 68101, where it sustained damage to its front bumper, passenger-side door, and rear axle.

• The incident occurred when another vehicle struck the front end of my vehicle while it was parked at the location mentioned above. The force of the collision caused significant damage to the bumper, with visible dents and scratches on the front end. Additionally, the passenger-side door was dented and scratched, and the rear axle was slightly misaligned.

• The damage was assessed by a certified mechanic, Clint Renner, who confirmed that repairs would be needed to restore the vehicle to its original condition. A written repair estimate has been provided, stating that the total cost of repairs will amount to $2,500.00.

• The damage has been reported to my insurance company, DynaFive, policy number XYZ123456789, and a claim has been initiated under case number 2024-8901.

I affirm that the vehicle was in good working condition prior to the incident, and the damage described above is the result of the collision on February 15, 2050. The vehicle has not sustained any additional damage other than what has been described in this affidavit.

III. Acknowledgment of Damage

I, [Your Name], affirm that the vehicle described in this affidavit has sustained damage as outlined above. I acknowledge that the vehicle was involved in an accident, and I have provided accurate and truthful details of the damages sustained.

I also confirm that I have submitted the necessary documents to my insurance company to assist in processing the claim for repairs. I will cooperate fully with any further investigations or procedures required in relation to the vehicle damage.

IV. Notary’s Acknowledgment

I, Jeremy Marvin, the notary, affirm that [Your Name] has appeared before me and has sworn to the truth of the information provided in this affidavit. I have verified the identity of the affiant and confirmed that this affidavit was signed in my presence.

This affidavit was signed and notarized on February 15, 2050, in the state of Nebraska, and I certify that the affiant's statements are made under oath.

Name: Jeremy Marvin
Notary Public
Date: February 15, 2050

V. Conclusion and Signatures

By signing this affidavit, I, [Your Name], affirm that the information provided regarding the damage to the vehicle is accurate and truthful. I understand that submitting false information in this affidavit may result in legal consequences.

Name: [Your Name]
Affiant
Date: February 15, 2050

This affidavit serves as a formal report of the damage sustained by the vehicle described above. It is executed to assist with the insurance claim process and to provide documentation of the incident for legal or other necessary purposes.

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