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Home My WebLink AboutUntitled (2) � ri ,S-TATE'' CITE4M1 i*tffi tiS'O`T 1 ' ,Q I ' I ' u I +y IN a�vu 7J � i1�al n(MI I G lr ,�l Ft c ,lr .7,,,,,,, 4....5,....,..,....,.„ .,.;,,,....` 1�-;,,,,,,I",,% ,-1 1 '.C:ERTILF,I� �_\T;E )_F TI/I;TL FO'R-A M0T:TbR V"EHJ CJ.E =�15� ' e_. .''�� VEHICLE IDENTIFICATION NUMBER YEAR MAKE MODEL/BODY TITLE NUMBER 2FAHP71V99X131708 09 FORD 4D CVP F1210Y155 y,., DATE ISSUED ODOMETER TAX BASE CODE PLATE NUMBER CENTRAL OFFICE USE ONLY 05/01/09 10 027435 09 793AVC NEW 03/04/09 EXP 02 ''� 140 SECURITY INTERESTS DOB OWNER % - • CITY OF OAK PARK HGTS t 14168 57TH ST PO BOX 20070, STILLWATER MN 55082-3007 11111111111111111111111111111111111 Fill IMI I II IIIIINIIIIIIIIIIIIHhhIIlIIIl lel Z ASSIGNMENT BY SELLER TRANSFEROR �• ? FEgEI AL AN, STAT£LAWS REQUIRE THAT YOU STATE THE MILEAGE IN CONNECTION WITH THE TRANSFER OF OWNERSHIP.MINNESOTA LAW REQUIRES THAT YOU MAKE A :- DISCLOSURE ABOUT DAMAGE TO THE VEHICLE. A FALSE OR FRAUDULENT STATEMENT OF PURCHASE BY ANY PERSON IS A GROSS MISDEMEANOR OR FELONY. ODOMETER DISCLOSURE STATEMENT. I(WE)CERTIFY THAT THE ODOMETER NOW 0 IS ACTUAL MILEAGE 6,61 READS r (NO TENTHS)MILES AND TO THE BEST OF MY 0 EXCEEDS MECHANICAL LIMITS OF ODOMETER r;:, KNOWLEDGE THE ODOMETER MILEAGE: 0 IS NOT ACTUAL MILEAGE—WARNING ODOMETER DISCREPANCY `1: DAMAGE DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE,THIS VEHICLE: 0 HAS 0 HAS NOT(CHECK ONE)SUSTAINED DAMAGE,EXCLUSIVE OF ANY COSTS-TG REPAIR, 'A REPLACE,OR REINSTALL AIR BAGS AND OTHER COMPONENTS THAT WERE REPLACED DUE TO DEPLOYMENT OF AIR BAGS,IN EXCESS OF 70PERCENT ACTUAL CASH VALUE. ASSIGNMENT:I(WE)CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS,WARRANT TITLE,AND ASSIGN THE REGISTRATION TAX AND VEHICLE TO: 311 x , - `'SE)i.ER'S PRIN",ED NAME(S) DATE OF SALE BUYER'S PRINTED NAME(S) 1 SELLER'S ADDRESS DEALER'S LICENSE# BUYER'S ADDRESSlit 1 SELLER'S SIGNATURE(S) BUYER`S SIGNATUR (S) �` APPLICATION FOR TITLE BY BUYER TRANSFEREE . MUST BE SUBMITTED WITHIN 10 DAYS Pie se Prrtnt \` `. BUYER$NAME LAS FIRST MIDDLE GATES OF BIRTH BUYER'S DRIVER'S LICENSE HUBRIS'8 -.Si 11'11111111111 . . A0D'L BUYER'S NAM S LAST FIRS: MIDDLE BUYER S DRIVER S LICENSE NUMBE'.5 STREET 0i CITY COUNTY/CODE STATE EIP.CODE IS TRIS iVEFti L,E SUEI,IECT TGA SECURITY AGREEMENT S? 0 NO 0 YES IF YES,COMPLETE SECTION BELOW FOR A0OmONAL SECURED PARTIES, .,,f; P1RSTSEC1111 p E DATE OF SECURITY AGREEMENT ATTACH CO.-LETED FORM P.8'2017 ,.PA''ll"9 NAME pRIN A '( 4 tl SIR@.EI ADDRESS ,,, - ,„ CITY 1P STATE .,< 000E ., -- ' >.[ I(WE)OERTIFY I(WE,)AM(ARE)OR L.EGAL AGE,HAVE PURCHASED THIS VEHICLE SUBJECT TO LIENS SHOWN AND NO OTHERS.I(WE)ATTEST BY THIS TRANSACTION THAT THIS VEHICLE WILL(OJ1'INUE TOSE` INSURED ' WHILEOPERATED UPON THEPUBLIC STREETS AND HIGHWAYS.ALL OF MY(OUR)DECLARATIONS ARE TRUE AND CORRECT. -' MIN:ESOTA COUNTY OR OTHER STATE ' W REVEHIDLEISIP.T APPLI ANtS/BU'YER`S$IGNATURE(S)All Must Sign �( NSPORTANT-* READ;ALL`INFOSHARTTQN COLLECTEOON A MOTOR VEHICLE APPLICATION IS REQUIRED BV LAW AND IS ISSUED TO IDENTIFY YOUR MOTOR `[' VEHICLE.FAUJIINFj PROVIDE REQUIRED INFORMATION AMTRESULT IN DENIAL OF THE REQUESTED AC110N.EXCEPT FOR CERTAIN USES PERMITTED BY FEDERAL L ,{�/ , s, AND STATE LAWS PERSONAL INFORMATION CONTAINED IN YOUR APPLICATION MAY NOT BE DISCLOSED TO ANYONE WITHOUT YOUR EXPRESS CONSENT.YOU MAY I: ' '.H f 1 .'I I i l s EXPRESSLYTANSENT TO tHE DISCLOSURE OF YOUR INFORMATION BY WRITING TO THE FOLLOWING ADDRESS: 'I' I Iti '#11 I I, I I l II'1 , ..r I I .1 MINNESOTA DEPARTMENT OF PUBLIC SAFETY r T 1 ll I I'll}IL'111 TPP DRIVER AND VEHICLE SERVICES DIVISION i4 ++ ' P flI `I I I II I I I I I `I 1I, 445 MINNESOTA STREET,ST.PAUL,MINNESOTA 55101 III 11 I I pyI 1 I I I I I i I `I 1 I il I `s PHONE 651-297-2126 TTY 651-282-6555 t,' ' I III 1 ,I 1I I ` I I ± ,, 'I I II 1 111+ti ` mndriveinfo.or IJ l 1 I �I 11 I I i I �I 1I(1� $1 11111111111111111111111110111111 700-1 a ; „ , , r� 1 '„i ' 'i•' : ,(� `_ PS2700-17 x ,i ..,+ 1 x� r �..a � y,� ��,:: - p 1m 0 1 I 1 ,, �,: x.• ,.. k c KnEEP•IN A S;AFE\jPLA,CE• jY N't.tt'R_ATIO�N OAR ERASURE.VOI�D'',' , LEJ ,' 1 i — 1 MINNESOTA MOTOR VEHICLE REGISTRATION SELLER'S NOTICE OF SALE YR MK MDL VIN When you sell this vehicle,you are responsible to file the information on the back side of this notice with the 09 FORD 4 D CVP 2FAHP71V99X131708 Department of Public Safety within 10 days.Please Sloth's information over theIntemetatmndriveinfo.org, PLATE * STICKER * TAX EXP call 651-284.1234,or complete all the Information on this notice and mail to the address below.This notice is not 793A V C KU 801509 5.00 02/28/10 required if sold to a licensed dealer.Minnesota statute 168A.10GROSS VEHICLE WEIGHT/BASE VALUE 027435 MINNESOTA DEPARTMENT OF PUBLIC SAFETY RECORDED OWNER(S) DRIVER AND VEHICLE SERVICES DIVISION CITY OF OAK PARK HGTS p g 445 MINNESOTA STREET,ST.PAUL,MINNESOTA 55101-5168 IIIIIIUIIIINlII11IYIIM1114168 57TH ST PO BOX 2007 TITLE NUMBER F1210Y155 VIN 2FAHP71V99X131708 STILLWATER MN 55082-3007 T,r,,- J t' s N ,ay FEDERAL AND STATE LAWS REQUIRE THAT YOU STATE THE MILEAGE IN CONNECTION WITH THE TRANSFER OF OWNERSHIP.MINNESOTA v " LAW REQUIRES THAT YOU MAKE A DISCLOSURE ABOUT DAMAGE TO THE VEHICLE. A FALSE OR FRAUDULENT STATEMENT OF PURCHASE , t' BY ANY PERSON ISA GROSS MISDEMEANOR OR FELONY. ki SALES TAX DECLARATION AND FEES REGISTRATION TAX ,;;g LL PURCHASE PRICE $ $ 4 LESS TRADE-IN ALLOWANCE PLATE FEE NET PURCHASE PRICE ARREARS TAX %OF NET PURCHASE PRICE LESS TAX PAID TO ANOTHER STATE NET SALES TAX DUE $ PSV FEE TRANSFER TAX TRADE-IN WAS A: TITLE/TRANSFER FEE MODEL MAKE PLATE OR VEHICLE IDENTIFICATION NUMBER YEAR SALES TAX Minnesota Dealer's License Number: LATE TRANSFER PENALTY I DECLARE Minnesota Sales Tax Account Number: SUBTOTAL $ THIS TAX EXEMPTION Internal Revenue Code Number(IRC): STATE/DEPUTY FILING FEE CODE: IRP Acct Number: If Leased,Lessee MCDP Number: TOTAL DUE $ REASSIGNMENT BY LICENSED DEALER ONLY I(WE)CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS, WARRANT TITLE,AND ASSIGN THE REGISTRATION TAX AND VEHICLE TO(BUYER): ODOMETER DISCLOSURE STATEMENT. I(WE)CERTIFY THAT THE ODOMETER NOW 0 IS ACTUAL MILEAGE READS (NO TENTHS)MILES AND TO THE BEST OF MY 0 EXCEEDS MECHANICAL LIMITS OF ODOMETER KNOWLEDGE THE ODOMETER MILEAGE: 0 IS NOT ACTUAL MILEAGE-WARNING ODOMETER DISCREPANCY DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE,THIS VEHICLE: ❑HAS 0 HAS NOT(CHECK ONE)SUSTAINED DAMAGE,EXCLUSIVE OF ANY COSTS TO REPAIR, REPLACE,OR REINSTALL AIR BAGS AND OTHER COMPONENTS THAT WERE REPLACED DUE TO DEPLOYMENT OF AIR BAGS, IN EXCESS OF 70 PERCENT ACTUAL CASH VALUE. I r SELLER'S PRINTED NAME(S) DATE OF SALE BUYER'S PRINTED NAME(S) SELLER'S ADDRESS DEALER'S LICENSE# BUYER'S ADDRESS X X SELLER'S SIGNATURE(S) BUYER'S SIGNATURE(S) ODOMETER DISCLOSURE STATEMENT. I(WE)CERTIFY THAT THE ODOMETER NOW 0 IS ACTUAL MILEAGE READS (NO TENTHS)MILES AND TO THE BEST OF MY 0 EXCEEDS MECHANICAL LIMITS OF ODOMETER KNOWLEDGE THE ODOMETER MILEAGE: 0 IS NOT ACTUAL MILEAGE-WARNING ODOMETER DISCREPANCY DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE,THIS VEHICLE: ❑HAS 0 HAS NOT(CHECK ONE)SUSTAINED DAMAGE,EXCLUSIVE OF ANY COSTS TO REPAIR,REPLACE,OR REINSTALL AIR BAGS AND OTHER COMPONENTS THAT WERE REPLACED DUE TO DEPLOYMENT OF AIR BAGS, IN EXCESS OF 70 PERCENT ACTUAL CASH VALUE. SELLER'S PRINTED NAME(S) DATE OF SALE BUYER'S PRINTED NAME(S) SELLER'S ADDRESS DEALER'S LICENSE# BUYER'S ADDRESS X X SELLER'S SIGNATURE(S) BUYER'S SIGNATURE(S) IMPORTANT-PLEASE READ: ALL INFORMATION COLLECTED ON A MOTOR VEHICLE APPLICATION IS MINNESOTA DEPARTMENT OF PUBLIC SAFETY REQUIRED BY LAW AND IS ISSUED TO IDENTIFY YOUR MOTOR VEHICLE.FAILURE TO PROVIDE REQUIRED DRIVER AND VEHICLE SERVICES DIVISION INFORMATION MAY RESULT IN DENIAL OF THE REQUESTED ACTION.EXCEPT FOR CERTAIN USES 445 MINNESOTA STREET,ST.PAUL,MINNESOTA 55101 PERMITTED BY FEDERAL AND STATE LAWS,PERSONAL INFORMATION CONTAINED IN YOUR APPLICATION PHONE 651-297-2126 TTY 651-282-6555 MAY NOT BE DISCLOSED TO ANYONE WITHOUT YOUR EXPRESS CONSENT.YOU MAY EXPRESSLY CONSENT TO THE DISCLOSURE OF YOUR INFORMATION BY WRITING TO THE FOLLOWING ADDRESS: mndriveinfo.org SELLER'S NOTICE OF SALE FOR YOUR PROTECTION Date of Sale Purchaser's Driver License Number UPON THE SALE OF A VEHICLE TO A PRIVATE PARTY, WE RECOMMEND THAT THE SELLER AND BUYER TAKE THE COMPLETED TRANSFER Purchaser's Full Name TO A DEPUTY REGISTRAR. 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