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O:__T,I,TtLE FOIR A MOTOR VEHICLE — r ` i' VEHICLE IDENTIFICATION NUMBER YEAR MAKE MODEL/BODY TITLE NUMBER , nt I a�ii 1FMFU16588LA33177 08 FORD 4W EPT H0210X479 4 DATE ISSUED ODOMETER TAX BASE CODE PLATE NUMBER 01/22/08 30 032190 09 XMC603 CENTRAL OFFICE USE ONLY � ' NEW 11/13/07 EXP 10 , NO SECURITY INTERESTS DOB OWNER �i;�� CITY OF OAK PARK HEIGHTS �.. 14168 OAK PARK BLVD N PO BX 2007 › OAK PARK HIS S MN 55082-3007 . 0 -17;,:cp;, ,_v 111111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIII11IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII • ODOMETER DISCLOSURE STATEMENT,I(WE)CERTIFY THAT THE ODOMETER DAMAGE DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE,THIS VEHICLE }�� LI HAS ❑ HAS NOT(CHECK ONE)SUSTAINED DAMAGE,EXCLUSIVE OF ANY COSTS TO REPAIR, ” 4 NOW READS (NO TENTHS)MILES AND TO THE REPLACE,OR REINSTALL AIR BAGS AND OTHER COMPONENTS THAT WERE REPLACED DUE TO_ BEST OF MY KNOWLEDGE THE ODOMETER MILEAGE IS: DEPLOYMENT OF AIR BAGS,IN EXCESS OF 70%ACTUAL CASH VALUE. 02'`` f% ❑ ACTUAL MILEAGE POLLUTION SYSTEM DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE THE POLLUTION ; CONTROL SYSTEM ON THIS VEHICLE INCLUDING THE RESTRICTED GASOLINE PIPE ❑ EXCEEDS MECHANICAL LIMITS OF ODOMETER ❑ HAS ❑ HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE. li Q NOT ACTUAL MILEAGE—WARNING ODOMETER DISCREPANCY Assignment:I(we)certify that this vehicle is free from all security interests,warrant title,and assign the. '4 registration tax and vehicle to: 0 / .Pf pp � � ra SELLER'S PRINTED NAME(S) DATE OF SALE BUYERS PRINTED NAME(S) < SELLER'S ADDRESS DEALER LICENSE# BUYER'S ADDRESS - c X SELLER'S SIGNATURES( BUYER'S SIGNATURE(S) ' IMPORTANT PLEASE READ: All information collected on a motor vehicle application Is required by law and is issued to identify ,' � your motor vehicle. Failure to provide required information may result in denial of the requested action. Except for certain uses � 1 i�� I" permitted by federal and state laws, personal information contained in your application may not be disclosed to anyone without 1� + + 1 , . i i5 1 102 your express consent.You may expressly consent to the disclosure of your information by writing to the following address: y, L t ' y MINNESOTA DEPARTMENT OF PUBLIC SAFETY + + r i r r i i i i IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII + + + + + + + + + + �i DRIVER AND VEHICLE SERVICES DIVISION + + + + + + + + , + ti 445 MINNESOTA STREET, ST. PAUL,MINNESOTA 55101 +� + +' + + + + + + + + i PHONE 651 1 r + + ✓'; PS2700 15 297-2126 TTY 651 282 6555 + +i J i + , t t z mndriveinfo org +r + + + + + + + + ` ii f�i/�yaj;:, ` -�7 aif,p �, f `ti.Y' _ `"', (Y �. - ,_f I s' `5' �.:�:: r,::�..1 v i ,y' r =r � —.s''LE--:', ;. 111'U` ?t ,��e ?�,I+,,,�,�� ,- ,, NSA�S,A�FhEt P'LA C;E; Y.N YtA L�T�ERFA�TI:O�N�O R ERAS U �IE�U�O IiD S;'T,H i S I T�L�Ef.,��"�� -,— SELLER'S NOTICE OF SALE When you sell this vehicle, you are responsible to file the information below with the MINNESOTA MOTOR VEHICLE REGISTRATION CARD Department of Public Safety within 10 days. Please file this information over the YR MK MDL Internet at mndriveinfo.org or complete all information on this post card and submit 08 FORD 4 W E P T by mail. This notice is not required if sold to a licensed dealer. Minnesota Statute 168A. 10 VIN IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1FMFU16588LA33177 H0210X479 1FMFU16588LA33177 GROSS VEHICLE WEIGHT/BASE VALUE 032190 Title Number Vehicle Identification Number PLATE# EXP Date of Sale XMC603 10/31/08 STICKER# TAX Purchaser's Driver License Number H 217 6 6 3 3 5. 00 RECORDED OWNER(S) Purchaser's Full Name Purchaser's Date of Birth CITY OF 0 A K PARK HEIGHTS '.:Street Address 14168 OAK PARK BLVD N PO BX 2 OAK PARK HTS S MN 55082— City County State Zip Code 3007 PLEASE PRINT I CONTROL Federal and state laws require that you state the mileage in connection with the transfer of ownership.Minnesota law requires that you make disclosures NUMBER about pollution control equipment and damage to the vehicle.A false or fraudulent statement of purchase by any person is a gross misdemeanor or felony. SALES TAX DECLARATION AND FEES FULL PURCHASE PRICE. . . . . . . . . . . . . . . $ REGISTRATION TAX $ 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 $ P.S.V FEE TRANSFER TAX TRADE IN WAS A: TITLE/TRANSFER FEE MODEL YEAR MAKE PLATE OR VEHICLE IDENTIFICATION NUMBER SALES TAX I DECLARE Minnesota Dealer's License Number: LATE TRANSFER PENALTY THIS TAX Minnesota Sales Tax Account Number: SUBTOTAL $ EXEMPTION Internal Revenue Code Number(IRC): STATE/DEPUTY FILING FEE CODE: Prorate Account Number(Sales tax due when registered): TOTAL DUE $ ASSIGNMENT OF OWNERSHIP ODOMETER DISCLOSURE STATEMENT,I(WE)CERTIFY THAT THE ODOMETER DAMAGE DISCLOTE EST MY WLDGE, ❑ HAS ❑ HAS SURE NOTSTA(CHECKEMENT.ONE)TOTHSUSTAINED BOF DAMAGEKNO,EXCELUSIVETHIS OF ANY VEHICLE COSTS TO REPAIR, NOW READS (NO TENTHS)MILES AND TO THE REPLACE,OR REINSTALL AIR BAGS AND OTHER COMPONENTS THAT WERE REPLACED DUE TO DEPLOYMENT OF AIR BAGS,IN EXCESS OF 70%ACTUAL CASH VALUE. BEST OF MY KNOWLEDGE ODOMETER MILEAGE IS: POLLUTION SYSTEM DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE THE POLLUTION ❑ ACTUAL MILEAGE CONTROL SYSTEM ON THIS VEHICLE INCLUDING THE RESTRICTED GASOLINE PIPE ❑ EXCEEDS MECHANICAL LIMITS OF ODOMETER ❑ HAS ❑ HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE. Assignment:I(we)certify that this vehicle is free from all security interests,warrant title,and assign the ❑ NOT ACTUAL MILEAGE—WARNING ODOMETER DISCREPANCY registration tax and vehicle to: SELLER'S PRINTED NAME(S) DATE OF SALE BUYER'S PRINTED NAME(S) SELLER'S ADDRESS DEALER LICENSE# • BUYER'S ADDRESS XSELLER'S SIGNATURE(S) BUYER'S SIGNATURE(S) APPLICATION FOR TITLE BY BUYER (TRANSFEREE). MUST BE SUBMITTED WITHIN 10 DAYS (P LEASE PRINT) Buyer's Name(s) (Last) (First) (Middle) Date(s)of Birth Buyer's Driver License Number(s) Street Address City County/Code State Zip Code Home Phone# Minnesota County or Other State Where Vehicle is Kept IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? ❑ NO ❑ YES (IF YES, COMPLETE SECTION BELOW)or additional secured parties, attach completed First Secured Party's Name(Print Name) Date of Security Agreement form No.PS2017 Street Address City State Zip Code I(WE)CERTIFY I(WE)AM(ARE)CONTINUE TO BENS RED WHILE LEGAL AGE,HAVE PURCHASED THIS VEHICLE SUBJECT OPERATING UPON THE PUBLIC STREETS AND HIGHWAYS.TO LIENS SHOWN AND NO OTHERS.I ATTEST BY THIS TRANSACTION THAT THIS VEHICLE IS AND WILL ALL OF MY(OUR)DECLARATIONS ONS ARE TRUE AND CORRECT. X APPLICANT'S/BUYER'S SIGNATURE(S)All Must Sign FOR YOUR PROTECTION UPON THE SALE OF A VEHICLE TO A PRIVATE Post Office Will PARTY, WE RECOMMEND THAT THE SELLER Not Deliver Mail AND BUYER TAKE THE COMPLETED TRANSFER Without Proper TO A DEPUTY REGISTRAR. Postage MINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER & VEHICLE SERVICES DIVISION 445 MINNESOTA STREET SUITE 168 RECEIPT FOR OFFICE USE ONLY ST PAUL MN 55101-5168 Registration Tax (if applicable) Sales Tax Total Fees/Taxes Paid