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Home My WebLink AboutUntitled (2) eMMIO 'i l''.' ti� At r r k,� ',Is, ., 7 . r— ,,..re,..' ..N,. ' 4- . x ��. 1t ',,', .y.,. !'s i rp , I ,T I ‘‘,'';..4.'W/''''','...I'4I � lT A T,41 l F �1N E kj)i,,`,4y N t ,iE/ - / :QIqti ,',f _4.4 ri4 .� �.. j - ^�•M(IYu"ihµ �� t ,. ,,1 rf lK(/Y at'l� ilk \ , ; �,M , i:ERThFIGAITOFITLEF ,R�AM0T0RVEHIlCE t,' Ca : T1a; t , � L _ /r,O VEHICLE IDENTIFICATION NUMBER YEAR MAKE MODELBODY TITLE NUMBER tF IFTWF3BY7AEA66885 10 FORD G3560Y486 ..,,' DATE ISSUED ODOMETER TAX BASE CODE PLATE NUMBER CENTRAL OFFICE USE ONLY ' i 12/22/09 10 000000 61 923743 ` - NEW 10/26/09 EXP 02 NO SECURITY INTERESTS DOB OWNER ,.. .. CITY OF OAK PARK HGTS it i 14168 OA PARK BLVD N OAK PARK MN 55082 II IIIIIlUIIUIfhIIIINIIIUI�III II IIIliIIIIIINIn1IglI IINluu1I11IIIMII lI }('�� ASSIGNMENT BY SELLER TRANSFEROR yl '- " FEDERAL AND STATE LAWS REQUIRE THAT YOU STATE THE MILEAGE IN CONNECTION WITH THE TRANSFER OF OWNERSHIP.MINNESOTA LAW REQUIRES THAT YOU MAKE A B DISCLOSURE ABOUT DAMAGE TO THE VEHICLE. A FALSE OR FRAUDULENT STATEMENT OF PURCHASE BY ANY PERSON IS A GROSS MISDEMEANOR OR FELONY, ODOME1 ER'.DISCLOSURE STATEMENT.I(WE)CERTIFY THAT THE ODOMETER NOW ❑IS ACTUAL MILEAGE READS (NO TENTHS)MILES AND TO THE BEST OF MY ❑EXCEEDS MECHANICAL LIMITS OF ODOMETER bp, - KNOWLEDGE THE ODOMETER MILEAGE: 0 IS NOT ACTUAL MILEAGE-WARNING ODOMETER DISCREPANCY /r DAMAGsBDISCLOSURE STATEMENT. TO THE BEST.OF MY KNOWLEDGE,THIS VEHICLE: 0 HAS ❑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. ASSIGNMENT:I(WE)CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS,WARRANT TITLE,AND ASSIGN THE REGISTRATION TAX AND VEHICLE TO: $yq '- SELLER'S PRINTED NAMES) DATE OF SALE BUYER'S PRINTED& &&D NAME(S}' >;) SELLER'S ADDRESS DEALER'S LICENSE# BUYER'S ADDRESS A SELLER'S SIGNATURE(S) BUYER'S,EIGNATIIRE(S) + APPLICATION FOR TITLE BY BUYER TRANSFEREE . MUST BE SUBMITTED WITHIN le DAYS Please Print 3 ERSNAME LAS FIRST MIDDLE BUYER'S DRIVER'S LICE•E,,,,,,,,,.,L,3 APIA, 1,,R'S LAS FIRST Millill1111 IIMIBUYER'S DRIVER'S LICENSE Numse S ' L r; STREETAu,a .S CITY COUNTY/CODE STATE .,'CODE j,. IS THIS gHIQL.E S I'3JECT TO SECURITY AGREEMENT S? 0 NO 0 YES IF YES,COMPLETE SECTION BELOW) FOR ADDITIONAL SECURED PARTIES, FIRST SECIJRo,P)n' SNAAE PIII T AME DATE OF SECURITY AGREEMENT ATTACH COMPLETED FORM PS2017 � STREETAp55A55 CITY .STATE Z.JP CODE .. > . Ith I(WE)CERTIFY I(WO AM(ARE)OF LEGAL AGE,HAVE PURCHASED THIS VEHICLE SUBJECT TO LIENS SHOWN AND NO OTHERS.I(WE)ATTEST BY THIS TRANSACTION THAT THIS VEHICLE ISAND WIL4 RONTINUETO SE INSURED WHILEOPERATEOUPON THE PUBLIC STREETS AND.HIGHWAYS.ALL OF MY(OUR)DECLARATIONS ARE TRUE AND CORRECT. , MINNESOTA COUNTY OR OTHER STATE c WHERE VEHICL E'IS KEPT APPL(oANVS/BUYER'S SIGNATURES)All Must Sign . `` wF RTANTA� ALL/NFDRMATWNCOLLECTEOONA MOTORVEHICLEAPPLICATION IS REQUIRED BY LAW AND IS ISSUED TO IDENTIFYYOUR MOTOR �., VEHIQLE f TfYPROVIDE REQUIRED WFORMATION MAY RESULT IN DENIAL OF THE REQUESTED ACTION.EXCEPT FOR CERTAIN USES PERMITTED BV FEDERAL AND STATE LAWS;PERSONAL INFORMATION CONTAINED IN YOUR APPLICATION MAY NOT BE DISCLOSED TO ANYONE WITHOUT YOUR EXPRESS CONSENT.YOU MAY EXPRESSLY. CONSENT TO THEDISCLOSURE OF YOUR INFORMATION BY WRITING TO THE FOLLOWING ADDRESS: + ` I MINNESOTA DEPARTMENT OF PUBLIC SAFETY 5 .I Ir I ;I''r'L I DRIVER AND VEHICLE SERVICES DIVISION 14 ` t �r++ tip 1� I 445 MINNESOTA STREET,ST.PAUL,MINNESOTA 55101 l I I F I 1 '1 �1 ) I I I I�PHONE 651-297-2126 TTY 651-282-6555 5 ` ± `I ± ± I rr 1 1 I I I Ir',- Ill!III II 11111 III 111 II III II I 1111 1111 1111 mndriveinfo.orq I , 1 11 i 1 11Ii 1 �?,h;.y7 ..,....,-4, PS2700-17 I'r I ,f,F � � � 1 ( y A r r•'ca , 3`� i.. ,. . � , 1 /1'( �;< r:,j `V'' .,!� c I"�.;µ, .: : � ��. � '�.>� E ' ilk 1KEEP IN'� S"A"FEjPLACE =MANY A.1:-rtF ATIgN OR" EIRA-S'URIE-VOIDS TH'I'SiTITLE ' , ,A.-.,A,u.,,,, ' .a. ,�;,,�a, e',t.N. a,,r. .t ,,, ,a,.,r. a,' .r,.a .,..+,*. d ..4..s, , " ,.a,, , rs�,aC'x t„fes,.'II wlZrw...w S:�;.it, n..:v..a,:' !1 .om,>....wL 8... I SELLER'S NOTICE OF SALE I MINNESOTA MOTOR VEHICLE REGISTRATION When you sell this vehicle,you are responsible to file the information on the back side of this notice with the YR MK MDL vIN Department of Public Safety yilthin 10 days.Please file this information over the Internet at mndrIveinfo.oro, 10 FORD 1FTYF3BY7AEA66885 call 651-284-1234,orcomplete all the information on this notice and mail to the address below.This notice is not PLATE * STICKER * TAX EXP requiredIf sold to a licensed dealer.Minnesota statute 168A.10 923743 K3039831 5.00 02/26/30 GROSS VEHICLE WEIGHT/BASE VALUE 000000 MINNESOTA DEPARTMENT OF PUBLIC SAFETY RECORDED OWNER(S) DRIVER AND VEHICLE SERVICES DIVISION CITY OF OAK PARK HGTS 445 MINNESOTA STREET,ST.PAUL,MINNESOTA 55101-5168 11111111111111INIIIIN w 14116 OA PARK BLVD N TITLE NUMBER G3560Y486 VIN 1FTWF3BY7AEA66885 OAK PARK MN 55082 CONTROL FEDERAL AND STATE LAWS REQUIRE THAT YOU STATE THE MILEAGE IN CONNECTION WITH THE TRANSFER OF OWNERSHIP.MINNESOTA NUMBER LAW REQUIRES THAT YOU MAKE A DISCLOSURE ABOUT DAMAGE TO THE VEHICLE. A FALSE OR FRAUDULENT STATEMENT OF PURCHASE BY ANY PERSON ISA GROSS MISDEMEANOR OR FELONY. SALES TAX DECLARATION AND FEES $ REGISTRATION TAX $ FULL PURCHASE PRICE PLATE FEE LESS TRADE-IN ALLOWANCE ARREARS TAX NET PURCHASE PRICE 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 SALES TAX YEAR 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. 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 COMPONENTS❑ AS TH NOT WERE REPCHECK rLACED DUE TO DEPLOYSUSTAINED MENT OF AIR BAGS, N EXCESS OF REPAIR,EXCLUSIVE OF ANY COSTS TO 0RCENT ACTOR UALREINSTALL AIR CASH VALUE. BAGS AND OTHER 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: mndrivelnfo.orq 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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