HomeMy WebLinkAbout1999 Ford Dumptruck 1
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} MINNESOTA MOTOR VEHICLE REGISTRATION/CAB C ARD
hi le—Services® ..igiv' ei ,:i.
This vehicle may have been issued a certificate of title. The certificate
of title is the only document that can be used to transfer ownership. If
there is a lien or loan associated with this vehicle, you must obtain a
lien release from the lien holder prior to transfer of ownership. If you
f do not have the certificate of title, contact Driver and Vehicle Services
or a deputy registrar for procedures.
Please Keep For Your Records
See Reverse Side for Contact Information
CITY OF OAK PARK HEIGHTS
14168 N 57TH ST BOX 2007 N DY F 0 0 8 3 414
STILLLWATER MN 55082-6409
1111 III'11111111111111111IIn1 I attest by this transaction that this vehicle in insured while
n
the public roads as required by law. Proof of insurance will b erated car ed in the vehicle.
(ii 165365 02/2006 99 FORD 1 FDAF57S2XED33333
Plate Expire Year/Make Vehicle ID2 $10.00 F08901471
Number Base/GVW Tax Title No. prey.plate 402034 165365
Lien Sticker Number
Jennifer Pinski
From: Andrew Kegley
Sent: Thursday, March 22, 2012 11:09 AM
To: Jennifer Pinski
Subject: Ford F550 Title
Jen,
The P.W. will be trading in the 1999 F550. We'll need the title on Friday.
Andy Kegley, Public Works Director
City of Oak Park Heights
651.4394439—Office
651.775.5759 - Cell
•
1
CITY F 3A K Al K-- H E 3 BUYER'S SIGNATU �� SALE DATE �
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14168TNT57TH �43OX �,G}1yr�V}1 i+�O )�7�'1 STREET ADDRESS - L
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l5) CIN STATE ZIP CODE
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„ V CERT�11ICATE OF TITLE r n ¢ ter-
;�', <,� ;° , , 'p k� `�' ""TQ A MOTi7®R VEHICLE �i'- i p T
" ail /� i/ 1� �THIS TITLE IS PRIMA FACIE PROOF OF OWNERSHIP;
/F �� ,tKEEP INA SAFE PLACE ANY ALTERATION 9,14,,,F,!,---,,-,-
R ERASURE VOIDS THIS TITLE >>-r
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1FDAFS7S2XE033333 1D ORD R) y
VEHICLE IDENTIFICATION NUMBER ODOMETER MAKE YEAR TYPE
F0890147103/30/9'9 NEW 03/08/99
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A TITLE NUMBERL
DATE ISSUED NEW OR USED IF NEW,.DATE OF FIRST SALE FOR CENTRAL OFFICE USE ONLY -`'
NO SECURITY NT 2 S 5 OWNER 008
O 00000 °�
CITE OF OAK PARK
HEIGHTS `':
v° 1 +158 N '57TH ST 30X 2007
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�'�'; STILLNA�'�R MN 55t)$2-3t7t�7 `�_;
..1 �L X5365 y....;:m
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ASSIGNMENT BY SELLER(TRANSFER
FEDERAL AND MINNESOTA.LAW REQUIRE THAT YOU STATE IHE LE,4GE IN CONNECTION WITH THE TRAN ER
.OF OWNERSHIP MINNESOTA. E4UIRES THAT YOU
MAKE DISCLOSURES ABOUT POLLUTION CONTROL EQUIPMENT/AND DAMAGE TO THE VEHICLE.FAILURE TO C PLETE OR PROVIDING A FALSE STATEMENT MAY;RESULT
IN FINES AND/OR IMPRISONMENT.SOME EXEMPTIONS MAY APR/LY.
.;
ODOMETER DISCLOSURE STATEMENT;1(WE)STATE THAT T ODOMETER NOW DAMAGE DISCLOSUR STATEMENT.TO THE BESTOF MY KNOWLEDGE THIS
READS VEHICLE
(NO TENTHS)MILE ND TO THE BEST 0 HA 0 HAS NOT(CHECK ONE)SUSTAINED DAMAGE IN y
OF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEA OF THE VEHICLE EXCESS OF 70%ACTUAL ASH:VALUE - q`
DESCRIBED HEREIN UNLESS ONE OF THE FOLLOWING STATE. NTS IS CHECKED. „rY '� a�
� POI-
D CLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE '
i ❑ (i) I HEREBY CERTIFY T�THE BEST OF MY KNOWLEDGF��THE ODOMETER THE POLLUTION CONT/P6 SYSTEMON THIS VEHICLE INCLUDING-THE RESTRICTED
^^ READING REFLECT
THE AMOUNT OF MILEAGE IN CESS OF ITS ,�� ,,
MECHANICAL LIMITS, - \''-
� GASOLINE PIPE /❑ HAS. 0 HAS NOT(CHECK ONE)BEEN REMOVED ;
[] (2) HEREBY CERT THAT THE ODOMETER READING IS NOT THF ACTUAL ALTERED OR;REy�RED INOPERATIVE _ `,�
�. MILEAGE. ��
1 WARNING-ODOMETER DISCREPANCY IF BOX(1)OR(2)IS CHECKED, A$SIONMEAkC WE)CERTIFY THAT THIS VEH CLE IS FREE FROM ALL SECURITY -a
INTERESTS,WARRANT TITLE AND ASSIGN THE VEHICLE AND REGISTRATION PAID TO
SELLER'S PRINTED NAME DATE BUYER'S PRINTED NAME
SELLER'S STREET ADDRESS'
,,,,,%%..,'"' SELLER'S BUYER'S ADDRESS
1 SELLER'S SIGNATURE BUYER'S SIGNATURE A }
cam. _
COMPLETE REVERSE SIDE APPLICATION FOR TITLE BY BUYER(TRANSFEREE) -4,
<'
PRINT BUYER'S FULL NAMES)LAST,FIRST,AND MIDDLE DATE(S)OF BIRTH
n t'��
;ti STREET ADDRESS CIN COUNTY STATE ZIP CODE
IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? NO ❑ YES' ❑ ADDITIONAL ❑"_,IF YES,COMPLETE SECTION BELOW '' ,�
',, FIRST SECURED PARTY(PRINT NAME) { 9' "*
- $_, �DATE'OFSECURITYAGREEMEt�ff
STREETADDRESS 'A
CITY STAT ZIP CODEI ~,
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IF THERE t$AN ADDITIONALPOLICY ,SECURINAGREMENT(S) INSURANCENUMBERX/ COMPLETE AND ATTACH 0F55017, COMPANY
I(we},certify I(we)am(are}of legal age,have bought this vehicle subject to liens shown and no others,this vehicle is and will continue to be insured while operating upon the
a I, public streets and highways,and all of my(our)declarations are true and correct. „
1'1'9'74441-
IMPORTANT'PLEASE READ:PERSONAL INFORMATION CONTAINED IN YOUR MOTOR VEHICLE RECORD MAV BE DISCLOSED TO ANY PERSON WHO MAKES A REQUEST FOR IT THIS PERSONAL INFORMATION .
MAY ALSO BE USED,RENTED OR SOL FOR USE IN SURVEYS,MARKETING,AND SOLICITATIONS TO RESTRICT THESE USAGES PLEASE CHECK THE APPROPRIATE BOX($)BELOW:
A DO NOT DISCLOSE MY INFORMATION TO ANYONE NOTAU7HORIZED BY LAW. 0 DO NOTDISCLOSE MYINFORMATION FOR SURVEYS,MARKETING OR SOLICITATIONS 0 b
oe
BUYER'S SIGNATURE(S)ALL BUYERS SIGN. BUYER'S DRIVER LICENSE NUMBERS)
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P �`O i (€ �+ y> r "h �' Lia .:\ ?y. °.•,,,,1,••,--.�. "�::,,,,...„,_•,„5..-,,,,,,,IS �,.�'".�'! ,,,,?.s
C t ..'L,4"C." . 5+. 3 .,r'•,� t.'' h�"�''.
APPLICATION TO TITLE/REG. A VEHICLE PLATE NUMBER YEAR FOR/ALIDATKJN AND OFFICE USE ONLY
FOR CENTRAL OFFICE USE ONLY
VALIDATION STICKER NUMBER 'EAR• '
WEIGHT STICKER NUMBER
I.,i L yr^ +4'b;
;,t.7.7. f "E ,iJT..,
,PkFA 'LI ei` .1,N-
07
_ NON-INOOTIAW UGISTRATUON MUM(CARD)ANY CAD CARD
TITLE TITLE REG REG TER PREVIOUS PLATE NUMBER YEAR MONTH YEAR THIS COPY WHEN VAUDATED(STAMPED ON THE UPPER RIGHT CORNER)BY
a ONLY ONLY CHANGE EXPIRATIONA DEPUTY REGISTRAR OR THE CENTRAL OFFICE WILL SERVE AS EVIDENCEOF
A (
/9 DATE TAX PAID FOR THE PERIOD INDICATED.THE REGISTRATION PLATES SHOWN ON
N 0 THIS RECEIPT HAVE BEEN ASSIGNED TO THE OWNER FOR USE ONLY ON THE
DATE OF PURCHASE CHECK NATURAL GAS VEHICLE DESCRIBED.
PURCHASER(S) �T 1999 NEW USED FUEL rso XOR PROPANE TRUCKS:
OWNERS) March VS, �/ TYPE DIESEL OTHER CEEEKPIFFTHIS VIOUSLY EI '!TRUCKS/TRAILLRS: NUMBER OF AXLES
MUST /1HAS
COMPLETE MODEL YEAR MAKE BODY/MODEL TYPE REGISTERED IN MINNESOTA
vehicle ► 1999 FORD DUMPTRUCK
information VEHICLE IDENTIFICATION NUMBER ❑ Do not disclose my information to anyone not authorized by law.
1 FDAF57S2XED33333 Cop BODY ROOF $ ❑ Do not disclose my information for surveys,marketing or solicitation.
PURCHASER(S) N.LAST,FIRST.AND MIDDLE NAME DRIVERS LICENSE NO./DEALER NO. DATE Of BIRTH
OWNER(S)
information CITY OF OAK PARK HEIGHTS I I
ADDITIONAL PURCHASER(S)OWNER(S)LAST,FIRST.AND MIDDLE NAME(S) DRIVERS LICENSE NO. DATE OF BIRTH(S)
I I
STREET ADDRESS CITY COUNTY STATE ZIP CODE
14168 N.57TH STREET BOX 2007 OAK PARK WASHINGTON c. i kiti 55082
NAME OF INSURANCE CO POLICY NUMBER HOME TELEPHONE NO
N. LMCIT CMC 18745
B ► IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)?
FIRST SECURED PARTY(PRINT NAME) YES NO F YES,COMPLETE SECTION BELOW.
TE OF LOAN FOR ADDITIONAL SECURED PARTIES,
PURCHASER(S) ATTACH COMPLETED FORM NO.PS2017.
OWNER(S) STREET ADDRESS CITY STATE ZIP CODE
MUST
COMPLETE
C1. MILES(NO TENTHS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER (SEE WARNING ON BACK OF LAST PAGE)
I(WE)THE OWNER(S)OF THE VEHICLE DESCRIBED ABOVE,CERTIFY THE ODOMETER ON THE VEHICLE NOW READS THE MILES AS SHOWN ON THE LEFT
AND THAT TO THE BEST OF MY(OUR)KNOWLEDGE.THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE DESCRIBED ABOVE UNLESS ONE OF THE
SELLER(S) 10 FOLLOW#JG STATEMENTS IS CHECKED.I(WE)THE OWNER(S)OF THIS VEHICLE CERTIFY THE VEHICLE IS FREE OF ALL SECURITY INTERESTS,WARRANT
MUST TITLE,ASSIGN THE VEHICLE AND TAXES PAID TO THE PERSON(S)NAMED ABOVE.
COMPLETE ❑ (T)I HEREBY CERTIFY TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS.
AND
SIGN 0 (2)I HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE.WARNING—ODOMETER1DISCREPANCY IF BOX(1)OR(4)IS CHECKED.
IP' DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THIS VEHICLE ❑ HAS IGT�_yIAS NOT(CHECK ONE)SUSTAINED DAMAGE IN EXCESS OF 70%ACTUAL CASH VALUE
► POLLUTIONSYSTEMDISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THIS VEHICLE INCWDING THE RESTRICTED GASOLINE PIPE
0 HASAFErIfLL[ <D NHAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE.
6* 5E 5 PRINTEAMES) COMPANY 3/" WTE
HIGHWAY 212 EAST DAWSON, MN 56232 STATE ZIPSELLER'S STB. _•,•..ESS -.—) CITY
SELLER'S SIGNA I )
PURCHASER'S MOTOR VEHICLE SALES TAX DECLARATION BASE VALUE OR REGISTRATION TAX + $ 4¢ C--e)
D a �l Q4 (� GROSS WGHT. PLATE FEE J�
1. PULL PURCHASE PRICE 39518.00 /�
REGISTRATION PERIOD ARREARS TAX
PURCHASER(S) 2 LESS TRADE-IN ALLOWANCE 1
OWNER(S) COMPLETE ITEM NG 6 FROM r.j,; itt��C, ro ,rr-l1 CONVERSION FEE
MUST p CHANGE OF GROSS V"EFRC<�E w iGHT (t
COMPLETE 3. NET PURCHASE PRICE 39518.00 TIME OF
AND HOURS STATE PATROL VEHICLE FEE t -7 )
SIGN 4.STs OF LINE 3
2568.67 TRANSFER TAX _ +
5. LESS TAX PAID TO ANOTHER STATE DATE OF T T L
NET SALES TAX DUE $ C CHANGE l I TITLE/TRANSFER FEE
6.TRADE-IN WAS A: MAKE PLATE NUMBER DATE EXCISE TAX -, c-�^
MODEL YEAR CHAEXPIRES I I LATE TRANSFER PENALTY
NIA CHANGE OF WGT.AND/OR CLASS SUB-TOTAL$ a
FROM TO
!DECLARE In NUMBER STATE/DEPUTY FILING FEE �; /
THIS TAX I(WE)CERTFY I(WE)AM(ARE)OF LEGAL AGE HAVE SOUGHT 1195 VEHICLE -.. Q!
EXEMPTION CODE SUSIECT TO LENS SHOWN AND NO OTHERS,THIS VEHICLE S AND WILL TOTAL DUE$
CONTINUE TO BE INSURED WHLE OPERATING UPON THE PUBIC STREETS
NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME. DATE - AND IRGHWAYS,THE VEHICLE WILL BE OPERATED N COMPLIANCE WITH �7 / rrr���
THE LAWS WHICH APPLY TO ITS CLASS Of REGISTRATION,HAVE RECEIVED J e-'f 1. /e /
A COPY OF US APPLICATION AND ALL OF MY(OUR)DECLARATIONS rI." fJ J
tr/L
AND CORRECLI)WE)FURTIER CERTIFY THAT F I19SEA COMMER-
CIAL VEIKIE I(WE)HAVE KNOWLEDGE Of STATE AND FEDERAL REGWM X y
TIONS APPLICABLE TO COMMERCIAL VEHICLE COMMISSION
OPERATION,MNNESOTA STAT. // /
COUNTY DATE MY COMMISSION EXPIRES EYES,CHAPTER 221,PLELK seem OGMMBSaN RULES 1 SHRTHROUGH 413, �,,.
AND CODE OF FEDERAL REGIKATKNJS TRIS 49,P4915 390 THROUGH
R399.EGULATI F A TRANSPORTER OF HAZARDOUS MATERIALS,CODE OF FEDERAL
REGIAATKXVS,TITLE 49,PARTS 171 TO 199. ,/
IDPS MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES DIVISION P.S.200019 SIGNATURE(S)(ALL PURCHASERS OWNERS(S)MUST SIGN) DATE
DO NOT SIGN UNTIL COMPLETED
'"`O1"O"`""'"'""'°"`" 445 MINNESOTA ST.,SUITE 100,ST.PAUL,MN 55101 (612)296-6911 PURCHASER'S(OWNER'S COPY)
TTY/TDD#(612)297-2100