The tag's own affidavit, doing two jobs from one page: turning a surrendered tag into money - a certificate of credit, or immediate credit toward the purchase of another tag - after the vehicle has been sold, traded or transferred; and replacing a tag or decal that was lost, stolen or destroyed, at $10.00 for a replacement license tag and $2.50 for a replacement decal, with a law-enforcement section for the stolen ones. Notarised either way: this affidavit must be signed before a notary public.
Written against 76-903 (Rev 08/21), issued under Miss. Code Ann. Section 27-19-65, whose false-affidavit penalty the form cites twice.
This affidavit is about the tag, not the title - swearing it does not transfer the car, and signing the title does not move the tag. A Mississippi sale is complete when both documents have done their separate jobs: assignment to the buyer, tag to the county.
Two documents, and they are not the same thing. Take the blank 76-903 from the dor.ms.gov copy so you get the revision that is current today, then print our 76-903 guide and keep it beside you while you fill theirs in.
This is the actual 76-903, rendered from the PDF the Mississippi Department of Revenue, Motor Vehicle Services publishes and completed end to end: letterhead, every field, and the blocks at the foot.
Amber — you write it
Grey — not yours to fill
Numbered — explained below
The actual 76-903 at Rev. 08/21, sworn the day after the sample sale. One box ticked on the credit side, the sold-on date sworn in the second reason, and the entire lost-or-stolen apparatus - police agency, case number, NCIC - correctly ignored, because this tag is not missing; it is on the counter, turning into credit from the first of next month. The signature line stays empty on the sample for the same reason it must not stay empty in life: it is signed in ink, before a notary, or the affidavit is nothing.
Field by field
Every line, in the order you meet it
1
You fill this in
County, date, and which of the four boxes
Your county, today's date, and - for a sold car - Certificate of Credit or Immediate Credit toward another tag.
Watch out: Same-month car replacement takes the immediate credit; any other timetable takes the certificate, which travels to any Mississippi county with you.
2
You fill this in
The sworn reason, with its date
The sold, traded, transferred box, and the date it happened.
Watch out: This date is checked against the assignment you wrote on the title - one sale, one date, three documents that all agree.
3
You fill this in
The vehicle and the tag's numbers
Make, year, model, VIN, tag number, decal number, expiration date.
Watch out: The decal number is on the sticker itself and on your registration receipt - bring the receipt, because the counter will want the record found fast.
4
You fill this in
Skip the police block - or don't
For a sold car, the law-enforcement section stays empty. For a lost or stolen tag, it is the heart of the form: agency, case number or report, NCIC entry.
Watch out: A tag stolen off a car you still own is the other life of this form - report first, swear second, and the promise to surrender a recovered tag is part of what you sign.
5
You fill this in
Swear it, hand over the tag
Sign before the notary, then surrender the tag at the Tax Collector's counter with the affidavit.
Watch out: The county's corner - tag deleted from system on, by - is the moment your ownership record stops being current. That line, filled in by a clerk, is the Mississippi seller's finish line.
At a glance
What goes where
On the form
What to put in it
County and date
County/seat and the date across the top - the county because the credit lands, and the replacement issues, at the Tax Collector's counter.
What you are applying for
Four boxes in two pairs: Replacement Decal (Fee $2.50) and Replacement License Tag (Fee $10.00) on one side; Certificate of Credit and Immediate Credit Toward the Purchase of Another Tag on the other.
The two sworn reasons
Reason one: the tag and/or decal has been lost, stolen or destroyed on a date, and if recovered will immediately be surrendered to the Tax Collector and not displayed on any vehicle. Reason two, the seller's: the said vehicle has been sold, traded, transferred, or in the case of vehicles with a GVW of 16,000 lbs. or greater, discontinued from use on a date.
The vehicle description
Make, year, model, VIN, tag number, decal number and expiration date.
The lost-or-stolen extras
For that route only: the registered owner's name and address, the law enforcement agency, a case number or attached copy of the report, and whether it was entered in NCIC or a local system.
The oath and the county's corner
The certification that everything listed is true, over the printed warning that the penalty for signing a false affidavit may be found in Section 27-19-65, the taxpayer's signature, the notary's sworn-and-subscribed block - and a county/state use only box recording when the tag was deleted from the system and by whom.
What gets this one rejected
•A photocopied form. The instruction line is blunt: copies or reproductions of the official form are not acceptable - the county wants its own stock under your ink.
•No notary. The signature line's flag says this affidavit must be signed before a notary public, and an unsworn credit claim is just a request.
•The wrong reason box for the facts. Sold is sworn with the sale date; lost is sworn with the loss date and the promise to surrender the tag if it resurfaces - swapping them to skip a police report is a false affidavit with a cited penalty.
•A stolen tag with no report. The lost-or-stolen block wants the agency and a case number or attached copy of the law enforcement report, and NCIC entry is part of what the county records.
•Waiting out of thrift. Credit runs from the first day of the month after the tag hits the counter, not from the sale - every month the tag sits in your garage is a month of registration you paid for and gave back.
Rules that decide whether it is accepted
•The seller's route through this form. Sell the car, pull the tag, and swear the second reason box with the sale date. If you are buying another vehicle the same month, take immediate credit toward the new tag; otherwise take the certificate of credit, which the FAQ says you may use in any county in Mississippi. Move out of state and it is worth nothing - no refunds, only credit.
•The stolen-tag route. The FAQ's version matches the form: get the form from the county, have local law enforcement complete their part, and the Tax Collector issues a substitute tag and decal - the fees printed on the form itself. The sworn promise to surrender a recovered tag is what keeps two copies of one number off the road.
