Loading...
HomeMy WebLinkAbout98 Chevy Blazer CRASHED TOYS AMER BANK AND TRUST CO,NA S 7 0 2 9 30 -.. 1775 INDUSTRIAL BLVD 70-883/711 STILLWATER;MN 55082 05/27/2099 PAS'TO THE C)ty of Oak:Park Heights CT $ *****2,775.00 ,_.__Q1�DEFLCiF g -- 'Two Thousand Seven Hundred Seventy-Five and 0/100 DOLLARS 8 LIFE- . O Paid for 278535-CT-Sti, Claim#: consignment, 1998 = Chevrolet.Blazer, 1 GNDTI3VNXW2161104 11170 2930" 1:07 LL088341 II' L6099Ili' CRASHED TOYS S 702930 Vendor: City of Oak Park Heights-CT Payee: City of Oak Park Heights-CT Address: 14165 57th St. R E C E s V ED Stillwater, MN 55082-6409 Snaps Check#: 702930 JUN - 8 2009 Check Amount: 2,775.00 Description: Paid for: 278535-CT-Sti, Claim#: consignment, 1998 Chevrolet Blazer, 1 GNDTI3WXW2161104 CRASHED TOYS S 702930 Vendor: City of Oak Park Heights-CT Payee: City of Oak Park Heights-CT Address: 14165 57th St. /1 Stillwater, MN 55082-6409 cE/V�D Snaps Check#: 702930 JUN. 81909 Check Amount: 2,775.00 Description: Paid for: 278535-CT-Sti, Claim#: consignment, 1998 Chevrolet Blazer, 1 GNDT13WXW1W2161104 E R **f- '4, 572856(11/08) Proceed Statement CrashedToys _ 1775 Industrial Blvd. Stillwater, MN 55082 Phone/Fax: (651)430-3306/ Tax ID: Wednesday, May 27, 2009 Adjuster: Brian Derosier City of Oak Park Heights-CT Claim#: consignment 14165 57th St. Policy#: Stillwater MN 55082-6409 Insured: City of Oak Park IIIIIIIIIIIIIIIIIIIIIIIIIII Claimant: City of Oak Park Stock#: 278535-CT-Sti Year: Make: Model: ACV: VIN: 1998 Chevrolet Blazer 1GNDT13WXW2161104 Loss: Call: Release: Pickup: Sale: 5/8/2009 10:36:00 AM 5/8/2009 5/8/2009 5/19/2009 Auction Charges Pool Fee 200.00 Total for Auction Charges 200.00 Total for ALL charges 200.00 Less Previous Payments 0.00 Less Bid Received 2,975.00 Buyer Keith Gehrman/Margaret Gehrman 2128 210th ave deer park WI 54007 CHECK ENCLOSED, FOR-----> 2,775.00 Gross Recovery: % Reported to NICB on: Net Recovery: % . . •rk ` °%i'p}p'1iw "i� v3 `"rL'.•}a�IpWbn r .rii7�"��`.4..a�,7.... .r�"rA` "', +; ,„,„�. " ,A,. qp, ' �f��S'..t ..t".. ...3 _ "tl•:...•1a44:1.-.d1 .A i.:-�6 �.,!<.• #C/voitro 1C4' Nk1 474 CERTIFICATE OF TITLE FOR A VEHICLE �. 1GNDT13WXW2161104 98 CHEV 4W BZR 111630N378 ar, 4 v'.ICLE IDEN,I,ICAt Ch NLMBE, ,C,M, •_ MANE MODEL 1- -4 ., , .- TITLE NUMBER .......................^__ _. .._ "•4444 �'t 06/12/01 42336 25691 • 10 BUJ328 •` DATE ISSL ED ODCME-EP. .BASE ::LASS •_ArI?NIMBI'S 4 EXP 07 CENTRAL O'YICc USE ONLY NO SECURITY INTERESTS OWNER DOB AI 4 CITY OF OAK PARK HTS )j / 4 14168 OAK PARK BLVD BOX 2007 M' 0 4 OAK PARK HTS MN 55082-6476 /l M DI Z *,. ASSIGNMENT BY SELLER(TRANSFEROR) FECEP_AL.ANC:TA E..A'W5 REr.LIIRF THAT'O.1-TATE THE tAII.rA:.r.N '•.'.r:: '•' :.'T'+.rrr TRANSFER OF OWNERSHIP STATE LAWS REQUIRE THAT YOU MAKE Ar/ DISCLOSURES ABOUT THE POLLUTION CONTROL EQUIPMENT AND',AM.Atir TO THE VEHICLE cAILURE TO COMPLETE OR PROVIDING A PALSE 3 LAiEMeht MA, ! RESULT IN FINES ANQOR IMPRISONMENT.SOME EXEMPTIONS MA's APPL'r // ODOMETER DISCLOSURE STA^EMEA-.-ea.re-.x;?^a: ..:Tele^:e,:o- E:AtM..I t:I`SC'-.OSURE STATEMENT To fro so,!of rry arrowrJga ars vorrrla f` 16(a Cr, .At, V tIAS NOT.G:Y.A'Ylel.wiia^t70WNid,'-lES1V:1"0-<a[loa as1's-a L ( ^:•rt,.4t I.7:::•o ,'.•-t.-:.n e:;•-.- ...•r•.c,0: u!:..;,ICN.S bTESI DISCLOSURE STATEMENT To to oast d.my,•nosmmin mn t ork.ACTUAL MILEAGE �( :.•I..x. r•++yxNr'M!mc',Moe*',Moe*vtduanp:no reavlaea gaaosw PW ^�' EXCEEDS MECHANICAL LIMITS OF ODOMETER •'4S HAS NOT does a o,Lea,removta.u.tarao a mrdcroa.rMa,.I.eD NOT ACTUAL MILEAGE•WARNING ODOMETER DISCREPANCY VA NI— A$$i(MA T II•CERTFY THAT THIS VEHICLE S FREE FROM A.L 3nFYQ J INIIRES`S WARRANT TITLE.AND ASSIGN THLBEGJFITAT Q(JAX AND VEHICLE'O ki PA if •e Oeeeriet 511gtCP) Oat sv•edT V SELLERS PRINTED NAMEIS. —__• ...:, DATE OF S-ALyE y BUYERS PRINTED NAMEIS) ,_•,,,, , $1 y,.4 SELLERS ADDRESS - BUYER' \ - .. _ 1 TI gm 0( SELLERS SIONATUREISSALL SELLERS MUST SIGN j BUYERS S ^ UREIS)ALL BUYERS MUST SIGN APPLICATION FOR TITLE BY BUYER(TRANSFEREE).MUST BE SUBMITTED WITHIN 10 DAYS(PMese Print) f I) fiiBu eraNemele ILast T• - --•ny1 .__ ._.Y. _.._—.l... �.. 1 )....l 1....! dela::_-_-•! -IIaTa(a)of.Bmli I Ztra DtNM lcen►e .NOm6r iFt3i I , slnel Address ; CIH ... CountytCode stare i....ZIP cafe I Name d -----._.. -.1 Pob Irlawar ea cy I Number Comps y IS THIS VEHICLE SUBJECT ro SECURITY AGREEMENT(S)? .. NO YES (IF YES.COMPLETE SECTION BELOW) --.. ... . .... ....... .. ....... ...........-- I rc,arto5r: :stir On-::-ere: I( Rest Secured Party's Name(Pr•nt Name) _..•• ! Date of Secures Agnxment . A_vc�;•- .,ate 41, street Aooress _ _ — . .• _ _ _ • Cit I State • ZI2 Coae ,/P'syw,77 k I rum Coolly I iwe)sm Inre..ot legal age.tow.,purchased this vehicle subtect to sena shown and no others TO p vehicle to and*51 continue to be rrhivre.'f y whle operating.::m the public stre is ars highways.All rd my burl oeClaratlons are We and correct. f 41 IMPORTANT••PLEASE READ:Air' [dadea or 'Tmt11:a4c a epp�el000 a-s•eyu'M by NA ^tele aa:a are used N atenbry yaw I`101a•0*101e.Fakes 10 0rson.regwriA MM may i 'eKO.r oval d Me'ep.ested act.P Except Id orlar .sex per-Rhea by team&arc Eal.laws tersonal srromraoi ConW`eo et your appNCa:xir may not be Clsoased»anyars 40110:: _UP yp.r express MSS..?°a.-..express o Comem'era A oe'000re Cl you'amoral e'Ormsscr by chedhng me appraorale oddest below: xi You may enclose my:,ers:•A'nen'^&:or In a^.ycre 'Co may macaw my mtormabcr!o,surveys.mewling o•sobdlavCmyr RP yik APPLICANT'S'BUYER'S SIGNATUREISI AN Must Srgn e '- -KEEPA N A-SAFEi'VCEL-r"'AN14AA rEI4AT1 e . -,9• ' RA IJIZE-4611:N4441.4 TI--UUE APPLICATION FOR TITLE AND REGISTRATION BY BUYER(S)CONTINUED CONTROL NUMBER 41012229 BUYER'S SALES TAX DECLARATION A FALSE OR FRAUDULENT STATEMENT OF PURCHASE PRICE BY ANY PERSON IS A GROSS MISDEMEANOR OR FELONY. FULL PURCHASE PRICE _S REGISTRATION.TAX • S .----.Tr LESS TRADE•IN ALLOWANCE . . . . .. . PLATE FEE ' NET PURCHASE PRICE ._.__.__.. .,_,. ARREARS TAX i I e.OF NET PURCHASE PRICE . . ___.__... _._.... . . .:_._. — I LESS TAX PAID TO ANOTHER STATE .. P.S.V FEE NET SALES TAX DUE S TRANSFER TA? ' TRADE-IN WAS A: TITLE.TRANSFER FEE I 7.•l- Imo'/FLAN- MAKE FLA-ECA VE•r'CLE OE". a CAT:\'.CITY?c SALES TAX T— -- -I - _ L. I DECLARE THIS M•nnesota Dealer L.cense Number: LATE TRANSFER PENALTY I S r TAX EXEMPTION I— I ' CODE Minnesota Sales Tax Account Number: SUBTOTAL . Internal Revenue Code Number(IRC": STATE'DEPUTY FILING FEE IProrate Account Number: • (Sales tax due wner•,registered' _ TOTAL DUES I TO DETERMINE EXEMPTION CODE OR ANY TAX AMOUNT.CONTACT A DEPUTY REGISTRAR OR THE I I DRIVER AND VEHICLE SERVICES DIVISION 1 •EL`E'NA.AND STATE-AWE FEOu•RE"I•AT YCU STA'E'I'E M 1rADE I.1 CopNr^:h v;TI•Y. 'PA'SrEP Cr OWNEASIrrO V•.NESOTA LAW AECUIRES"HA-YOU MAKE DISCLOSURES mow L'C11W...A CO4'I'OL NC-I°MIA'•1\L':A'.:AGE' "-E v5-i_). AA•_..+E" ':'FL_-E:>AFS...,:\G A FA_SE ".•15•.15\r MAY FNSU_T IN LINES AM)OF IM'mISO'MFsr SOME ExEMPYIONS MA,APPLY M b •RBA A:ao0:M5 r0°A'.IONr"AA.Pe\m"• r A"Fm.)rry:r f:•:Mr-{ -Y NOT rqE:.,Y T•..h•d DAYS OF TIE DATE OF SALE HOWEVER THIS )CLS NOT APPLY.0 r1'A4Sr EN•• 0..7 BE:WEEN DEA_SRS REASSIGNMENT BY A LICENSED DEALER ONLY • ODOMETER DISCLOSURE STATEMENT:((WE)CERTIFY THAT THE ODOMETER DAMAGE DIECj.OSURE STATEMENT To 5.0 best of my knowledge this vehicle (o, r7 i:HAS .C. AS NOT'check one;Miami damage in excess of 70°.actual cash value. NOW READS `-� v�v (N9 TENTHSJMILES AND TO THE BEST OF MY KNOWLEDGE THE ODOMETER MILEAGE IS. POLLOTION SYSTEM DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE 7HE POLLUTION CONTROL SYSTEM ON THIS VE-(CLE INCLUDING THE RESTRICTED GASOLINE PIPE TUAL MILEAGE C•IAS (HAS NOT(CHECK ONE)BEEN REMOVED.ALTERED OR RENDERED INOPERATIVE EXCEEDS MECHANICAL LIMITS OF ODOMETER / .NOT ACTUAL MILEAGE•WARNING ODOMETER DISCREPANCY ASSIGNMENT:I(WE)CERTIFY THAT THIS VEHICLE LS FREE FROM 4LL SECURITY INTERESTS.WARRANT TITLE.AND ASSIGN THE REGISTRATION TAX AND VEHICLE Tt0• �.raXhoc ly �1�i/ I Y�,I. '• t 11 EL 6 PRINTF AM� /�l r.47r.d oPIE BUYE_E PRINTED- (S) �' (ArtilgiN3.054. ��••tjjwwjj,//tt\aa((aw�i1//vvAA.. •—.•' WV: 4 Y ADDRESS O[AL[P ICCNSti• •• !. BVVER'S ADDRESS —SELLERS S)ANAYUAE181 —__ I�i,1/1�� : „ T- 1 REASSIGNMENT BY A LICENSED DEALER ONLY ODOMETER DISCLOSURE STATEMENT.I(WE)CERTIFY THAT THE ODOMETER DAMAGE DISCLOSURE STATEMENT Tx me best d my knowledge ma rake* 71 HAS 0 HAS NCT(mock bnel sustaeled damage In excess of 7O%actual case eek*. NOW READS (NO TENTHS)MILES AND TO THE BEST OF MY KNOWLEDGE THE ODOMETER MILEAGE IS. POLLUTION SYSTEM DISCLOSUPE STATEMENT.TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THIS VEHICLE INCWDMIG THE RESTRICTED GASOUNE PIPE. .. ACTUAL MILEAGE D HAS El HAS NO'(CHECK ONE)BEEN REMOVED.ALTERED OR RENDERED INOPERATIVE EXCEEDS MECHANICAL LIMITS OF ODOMETER .NOT ACTUAL MILEAGE•WARNING ODOMETER DISCREPANCY ASSIGNMENT.*I(WE)CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS.WARRANT TITLE.AND ASSIGN THE REGISTRATION TAX AND VEHICLE T0.' SELLER'S PRINTED NAMHS) • DATE OF SALE BUYER'S PRINTED NAME'S) LL S A awn— — DEALER S LICENSE e - BUYER'S ADDRESS X • X SELLER BSITTNATOAE EI.. — _— INNERS SIGNATURE(SI INS CER-rRICATE'S SSJED BY a A,w es rota m a'?Cl 4,40 weak, x 14:e1Cetlta M$V-rvrc leer r.nenao•aro 00vt0 'I-r MINNr5OTA DLPCITMENI 0,IM'CLIC SALETv r..... i.N once.........I r.a^e•r n•..••r::....•.n-e 1 a.ew re earn.rplwoa 0111 MM T..u:••am,:• DRIVER AND VEIeC.E SEPV.CES DIV 501. me F4061e m Cera-[WY EV:0"o'IFI.e^:a • I o^a••eCSAt0 acto- 4451AMNdESO A NE=T gT PAUL MINNESOTA 5510' O<wr:v.a.•a- ..1W u••+au C..511,1 A•o$1.e.Fewe F1•e'Te•10*Yato-CC:l1.'.ee a Yta'Aotga:o-ro. PHcx.E 851.297.1126 1"rY 651.282 6555 .:a a....,•.,,,.a - =' r, n. $TY YL.."lay ler.u1 Y<M1,60,1 as'I 440 01••••01 y0..• Au.s..ax.•..a•• MMa•YY•ve-w cr•x•')'•4 •p-1 r:or>I IM bun el Iva raensaN or.IM P.S..27eP 10 •,1 ft 1 ..• s s_. ,M�\_IL:. _.�x.� V > R "_�--d', '! ]A..�'�6 � � �� i•` �� } STAE OF MIsN,NESOTA X r CERTIFICATE OF TITLE FOR A VEHICLE 1GNDT13WXW2161104 98 CHEV 4W 13---:R- ZR H1630N378 ' ', a VEHICLE IDENTIFICATION NUMBER YEAR MAKE MODEUBODY TITLE NUMBER I'` '' 4 w 06/12/01 42336 25691 10' BUJ328 y DATE ISSUED ODOMETER TAX BASE CLASS PLATE NUMBER N. is ",• EXP 07 CENTRAL OFFICE USE ONLY ,,� >a O SECURITY INTERESTS OWNER DOB ` * . i CITY of,OAK PARK HTS , • 14168 OAK PARK BLVD BOX 2007 I OAK PARK r HTS MN 55082-6476 i4 �/ / ASSIGNMENT BY SELLER 1��� �.��� ' 'r FEDERAL AND STATE LAWS R Q,,J.6. HAT YOU STATETHE MILEAGE IN CONNECTION WITH THE FE .ir} ' N#)4&hl1t,,S'TA`f'L L#riV S REQUIRE THAT YOU MAKE DISCLOSURES ABOUT TfE"''OL'hkirpr>f CONTROI,EQUIPMENT AND DAMAGE TO THE VEHICLE.FA'( 5� EtE(`)1 Pi TIDING A FALSE STATEMENT MAY 4 RESULT IN FINES AND/Ok)MPRISONMENT SOME EXEMPTIONS MAY APPLY., ODOMETER DISCLOSURE ST>xTTME T"I(we)cerafy;that,the tidomter now reads DAMAGE DISCLOSV/FtE/y'TATEmENT T4tFjfr%best of my knowledge this vehicle 0 HAS 0 H" T'g ySUsteined damage in excess of 70%achialxastl value. (no tenths)rfidiis and t0 the best of my knowledge the odometer mileage is: POLLUTION SYSTE CLCD N[i ,STATEMENT,To the best of my knowledge the 14 , pollution control systyfhbfFthff/etiicte including the restricted gasoline pipe k. _, ❑ ACTUAL MILEAGE ,;. 0 EXCEEDS MECHANICAL LIMITS OF ODOMETER 0 HAS 0 HAS,NOT(±'heck one)been removed,altered,or rendered inoperative. p`• NOT ACTUAL MILEAGE WARNING ODOMETER DISCREPANCY i ASSIGNMENT: I(WE)CERTIFY THAT THIS VEHICLE IS"FREE FROM ALL SECURITY INTERESTS WfJTTITLE,AND ASSIGN THE REGISTRATION TAX AND VEHICLE TO: c- SELLER'S PRINTED NAMES ''D`AT/E'/QF% "E It.S PRINTED NAME S SELLER'S ADDRESS „ ,''',./;, � iS�Y ESS �,/r .,,,/,..„-,„, e SELLER'S SIGNATURE(S-ALL SELLERS MUST.SIGN, „s,..,,,,,,,,:,,,,,,.% 2 ,% 'SlctlATIJRE S ALL BUYERS MUST SIGN 1�;, . APPLICATION)O TIT E,BY".BUYER'(TRANSf I • „g'' BMITTED WITHIN 10 DAYS(Please Print) s a ✓� �,<f t Y .Bu et s.Name s Last Fust, M ddfb ', t t a•I `` Bu e`r's.Drive�License Nrli�iber s Street Address )t�% 1 / cxjpty(Code State Zip Code Name o !r/ zf o // ' P t. Insurance '„ '/)). "/;<'''/''/',/ %i t: Company _, , // r /./ ; Y a IS THIS VEHICLE SUBJECT TO SECUF(ITY AN',FEE BYES (1j°1`E;� COMPLETE; SECTION BELOW) ” For es; nal secured ' '.., .„-,,,,,./..' ,, ;G j parties,attach Completed d- First Secured Party's Name(Print Name). ''''.',,''''''''-'<''''-'- ;. �T /`"" Data of"Securi Agreement form No.PS2017 4:- 1 Street Address City State Zi. Cotte ; .1 (we)"6ertify `I (we) am (are) of legal age, have purchased this,vehicle'subject to liens shown and no others. This vehicle' is and will continue to be insured .., while operating upon the public streets and highways.All of my(our)declarations are true and correct. h;;, IMPORTANT- PLEASE READ: All data collected on a motor vehicle application are required by law.These data are used to identify your motor vehicle.Failure to provide required data may result in denial of the requested action. Except for certain uses permitted by federal and state laws, personal information contained in your application may not be disclosed to anyone without a your express consent.You may expressly consent to the disclosure of your personal information by checking the appropriate box(es)below: w+ [] You may disclose my personal information to anyone. ❑ You may disclose my information for surveys,marketing or solicitations. typ ... M' # ,p APPLICANT'S/BUYER'S SIGNATURE(S)All Must Sign �� p:� ��tg,. ! =ac an :t fi yy_¢ .1 , :int '., v:,a s�c•ji w�n` n t:.,. fl k a,;,s a s g, ITLE }� . ,KEEP INA SAFE PLACE ANY ALTERAT.ION 0,RrERASWiRE VOIDS THIS ,, `.. .k` M... ..art)°txr.. > :.*:i. +d`$:_. ,. °I, ^: . ' ,;>rpgn , .ib '�i.. ': .o+ ^^, ' ?? .. ik.. X"'^'",a; „, ,:..�rdsbr$_.. + bdcierite, MC S 5900FAStiILYllwaterOWNED BoulevardSINE North1922•P.O. Box 337 MOTORS Stillwater,MN 55082 BUICK • CHEVROLET • JEEP (651)439-4333 Stock# 2523P Date: 05/10/01 salesperson: THOMAS M JOHNSON CITY OF OAK PARK HEIGHTS Buyer Name:(Last) (First) (Middle) Co-Buyer Name:{Last) (First) (Middle) 14168 OAK PARK BLVD. ) BOX 2007 AK PARK HEIGHTS MN WASHINGTON 55082 Address: City: State: County: Zip: Home Phone: (651)439-00((q,23 Bus. Phone: Buyer DOB: Co-Buyer DOB: S-525-522-603-574 Buyer D.L. #: Co-Buyer D.L.#: Buyers Insurance Co.: LEAGUE OF MINNESOTA CITIE Policy#: CMC 17704 PLEASE ENTER MY ORDER FOR: New CIUseM Demo❑ Lienholder Address T 98 dirkVROLET " EAZER Bret LT TAR ssloN IC $EIGEINTERIOR n vft NDT13WXW2161104 . ' J 328 TeB1EJUA/b1 E MILEAGE42336 ONLORABOU05/1O/01 CASH PRICE OF VEHICLE 15995,00 FREIGHT DEALER INSTALLED OPTIONS THIS VEHICLE HAS HAD ITEMS AND/OR ACCESSORIES INSTALLED WHICH ARE NOT COVERED BY THE MANUFACTURER WARRENTY. THESE INCLUDE: • TRADE-IN DATA iV§0 tvitVROLE "ltiE 00 BODE PICKUP VIN 14 2GCEK19K4L1245936 LIEN HOLDER'S NAME CUSTOMER INITIALS X ADDRESS ' LICENSE LICENSE EXP. PLATEN 005 LFR STATE MN DATE]O/30/( 1 MILEAGE 98'705 TRANSMISSION NOW DOES YOUR TRADE-IN HAVE A BRANDED YES 0 NO 0 TITLE OR INSURANCE SALVAGE HISTORY? m t ti4411 otim�� ', a ... , 1,4::::-, , trt order to comply Mil ttesti Statues`6emt =r C 09&i tt y5 ea,0:0 n*y TOTAL 15995,00 trans }r.a motor-ve i ))thOAt f ro tdtmgt.wrdten:' sure to the tranaferee.'-. (buyertcertrfytrrg the cdndttt n of the pdtte ittn pootroi system. LESS TRADE-IN ALLOWANCE FOR USED VEHICLE 6159,00 "ransferof elief)hereb 'rales,to the beat df lhtsTer knowledge,that the . pollution control system= this vehicle,being traded in,including the restricted ,gasoline pipe,has orb 0 re d,site or rendered inoperative. TRADE DIFFERENCE 9836,00 Seller's Signature® '.1 r- t ~+x.. LICENSE PLATEo rcr N!!1 STATE&LOCAL TAXES 639, 34 DEALER'S DISCLAIMER OF WARRANTY ' TITLE&TRANSFER FEES 15 ,00 FEDERAL LUXURY TAX N/A LIEN RECORDING FEE A /A DOCUMENT The Dealer expressly disclaims ail warranties,either express or implied on the ADMINISTRATIVE FEE 25 00 vehicle sold,except any warranties offered and explained in Paragraphs 10 through 13 on the back of this contract.Buyer acknowledges receiving this Information N/�' SERVICE CONTRACT N A before the:,sale and further knowledges having read and understood the provisions on the back f th s orfs c , TOTAL LICENSE&FEES 15,0U Buyers Signature® f I ". t,n/f�/,ij'ts" CASH SUBMITTED P-1/ SUBTOTAL S r WITH ORDER10 '1 5, 34 ' DEALER'S POLLUTION CONTROL SYSTEM DISCLOSURE LESS BALANCE OWING TO $k A (VEHICLE BEING SOLD) LIENHOLDER ON TRADE-IN Transferor(Dealer)hereby certifies,to the best of his/her knowledge, that the TOTAL DOWN PAYMENT N/A pollution control system onthis vehaltered, nd sold,includingpthe restricted gasoline TOTAL AMOUNT DUE ON DELIVERY pipe,has not been removed,altered,or rendered inoperative. 105i3, 34 The front and back of this CONTRACT comprise the entire CONTRACT affecting this purchase. The DEALER will not recognize any verbal agreement, or any other agreement or understanding of any nature.You certify that no credit has been extended by dealer for the purchase of this motor VEHICLE.You certify that you are 18 years of age or older, and acknowledge receiving a copy of this contract. The terms of this CONTRACT were agreed upon and the CONTRACT signed in the dealership on IMPORTANT: THIS MAY BE A BINDING CON— the date noted at top of this form.If DEALER is arranging credit for YOU,this CONTRACT is not valid TRACT AND YOU MAY LOSE ANY DEPOSITS IF YOU until a credit disclosure is made as described in Regulation Z and you have accepted the credit extended. DO NOT PERFORM ACCORDING TO ITS TERMS. NOTICE OF SALB'P SO 'S LIMITED AUTHORITY. This contract is not valid unless signed and `� accepted by Salep M'andge�r Officer of Dealership. i 1 Accepted •:'d ^� - , Buyer's Signature Accepting Terms of Contract This ODOMETER DISCLOSURE STATEMENT and ASSIGNMENT Refers to Vehicle Being Sold Federal and State law require that ou state the milea�re.0 on transfer of ownership.Failure to complete or providing a false statement may result in fines and/or imprisonment. I(we). STILLWATER IYI�TORS ,the owner(s)of the vehicle described below,certify the vehicle is free of all security interests. (Tiansleror's Name_Print) ,, ,5:_qt warrant title,assign the vehicle and taxes paid to the person(s)named below and state that the odometer now reads (no tenths)miles and to the best of my knowledge that it reflects the actual mileage of the vehicle,unless one of the following statements is checked. ❑(1) I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. ❑(2) I hereby certify that the odometer reading is NOT the actual mileage. WARNINGQ — ODOMETERQ }O �iI�TDISCREPANCY if box(1)or(2)is checked. T.f§ 8 L.2 tiROLET T LUE KkMODEL,I.1{ BOAC TV ET VIN.NO. 1GNDT.L. WXW216 i. -a LICENSE NO. i, i LIC.EXP.DATELL /.+ "OTTYRtP N tARuYP1F� ZI NTHEI GHTL L TRANSFEROR'S SELLER)STREET ADDRESS c�pp��a r��pp¢��t1'� .7R� TL�SI�yE.,rtn�r. LYLt` V 591)D STILLWATER BLVD. NORTH J[TI D'97reK. CARR BLVD. , BOX 20F..I/ CITY,-. 1 STATE ZIP 1 t 't.,f /ST LWATER MN 55082 CITY OAK PARK. IT.E IGH1 W MN 5 50 ZIP TF1AN4EkS-(SELLER).SIGNATURE(PRINT SIGNER'S NAME ALSO) �/) (X)\-A;;.-"'' TRANSFEREE'S(BUYER)SIGNATUA6 "NIN(f '�I4IER MEfALSO)(- r STATEMENT DATE 05/10/01 Receipt of copy acknowledged(5() ;' r y' 'r "�„_'�}J��'' -'- -'- This ODOMETER DISCLOSURE STATEMENT and ASSIGNMENT Refers to Vehicle Being Traded In Federal and,Sr aworuiFethat yi3uA�talg tb illt p„ugon transfer of ownership.Failure to complete or providing a false statement may result in fines and/or imprisonment. I(we), h,11 III/RRKK t' KKFF 11ttff..11 .the owner(s)of the vehicle described below,certify the vehicle is free of all security interests. IT rancleror'ti Name,Pnnt) 9 V 705 warrant title,assign the vehicle and taxes paid to the person(s)named below and stale that the odometer now reads y V (no tenths)miles and to the best of my knowledge that it reflects the actual mileage of the vehicle,unless one of the following statements is checked. ❑(1) I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. ❑(2) I hereby certify that the odometer reading is NOT the actual mileage. WARNING — ODOMETER DISCREPANCY if box(1)or(2)is checked. YEAR MAKE MODEL BODY TYPE 1990 CHEVROLET TRUCK K150u PICKUP VIN NO LICENSE NO I IC EXP DATE 2GCEK19K4L1245936 005 LFR TRANSFEREE'S NAME BUYER PRINT TRANSFEROR'S(SELLER)STREET ADDRESS STILLWATER MOTORS 14+168 OA'K PARK BLVD. , BOX 2007 STREET ADDRESS CITYltr.PARK HEIGHTS MN 5Tgrg2 ZIP tle 5900 STILLWATER BLVD. NORTH ���////// CITY ..ii._ STATE 550ZIP 82 TRANSFFT IV T)Si(' 4TlIR,F(PRINT SIGN.6R S NAME ALSO) STILLWATER MN ;x, V r �1k•J\ Cr ) 1 TRANSFEREE (BUYER)SIGN U SIGNER S NAME Al SO) / STATEMENT DATE 05/10/01 Receipt of copy acknowledged a) MADA 2436©Copyright MADA SERVICES,INC.(7-93)Reorder from MADA SERVICES,INC.277 University Ave.,St.Paul,MN 55103-(651)291-2400