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Home My WebLink About1997 Ford Crown Victoria APPLICATION TO TITLE/REG. A VEHICLE PLATE NUMBER YEAR FOR VALIDATION AND OFFICE USE ONLY FOR CENTRAL OFFICE USE ONLY pith, / Cr /� Pi YEAR VALIDATION STICKER NUMBER YEAR �� .a IQ 411 WEIGHT STICKER NUMBERVS OZ 9,0 lin, visig*„P 977088 STUART,BILL 04103°) TITLE TITLE REG. REG TFR PREVIOUS PLATE NUMBER YEAR MONTH YEAR A S REG ONLY ONLY CHANGE EXPIRATION DATE ` PURCHASER(S) DATE OP PURCHASE CHECK GySq,E NATURAL GAS OWNER(S) J �y.. C "' v NEW ,USED FUEL OR PROPANE — MUST �r� TYPE DIESEL OTHER COMPLETE ANDEL YEAR MMcE p BOOP/MODEL TYPE PLEASE CHECK IF THIS VEHICLE TRUCKS/TRAILERS: TRUCKS: vehicle I' 97 FORD P71 CROW HAS BEEN PREVIOUSLY EMPTY WEIGHT NUMBER OF AXLES information , REGISTERED IN MINNESOTA VEHICLE IDENTIFICATION NUMBER j 2FALP71W9VX167069 // COLOR BODY ROOF CODE: PURCHASER(S) ►LAST,FIRST,AND MIDDLE NAME DRIVERS LICENSE NO./DEALER NO. DATE OF BIRTH OWNER(S)ti CITY OAK PARK HEIGHTS I information ADDITIONAL PURCHASER(S)OWNER(S)LAST,FIRST,AND MIDDLE NAME(S) DRIVERS LICENSE NO DATE OF BIRTH(S) I STREET ADDRESS CITY COUNTY STATE ZIP CODE 14168 57TH STREET M OAK PARK HEIGHTS MN 55082 NAME OF INSURANCE CO POLICY NUMBER _ �- HOME TELEPHONE NO. B. LEAGUE MN CITIES /.-iol' C„ I '—I f / , (612)439-47 B . IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? YES NO X IF YES,COMPLETE SECTION BELOW. FIRST SECURED PARTY(PRINT NAME) DATE OF LOAN I FOR ADDITIONAL SECURED PARTIES, PURCHASER(S) ATTACH COMPLETED FORM NO.PS2017. OWNER(S) STREET ADDRESS CITY STATE ZIP CODE MUST COMPLETE 4" C 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) FOLLOWING 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 ❑ (1)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 ❑ (2)1 HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE.WARNING—ODOMETER DISCREPANCY IF BOX(1)OR(2)IS CHECKED. ► DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THIS VEHICLE 0 HAS 111141NOT(CHECK ONE)SUSTAINED DAMAGE IN EXCESS OF 70%ACTUAL CASH VALUE ► POLLUTION if DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THIS VEHICLE INCLUDING THE RESTRICTED GASOLINE PIPE 0 HAS LLiJ(HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE. ► SUPERIOR FORD, INC. SELLER'S PRINTED NAME(S) DATE 9,10 56TH AVE. NO. put n'�I MN 55,14, SE R'S S r 1 ESS CITY STATE ZIP X A ,i �,.i A . ala/ , _.. r ' TUR 1 _ V D PURCHASER'S EXCISE(SALES)TAX DECLARA� • BASE VALUE OR REGISTRATION TAX + $ a 1.FULL PURCHASE PRICE $ 202074.00 --e��-I' te r PLATE FEE PURCHASER(S) REGISTRATION PERIOD ARREARS TAX 2 LESCO PEEIALIAWANCE N�A FRCFA TO CONVERSION FEE OWNERIS) COMPLELEITG TE ITEM N 6 MUST COMPLETEt1'.«} CHANGE OF GROSS VEF#CIE WEIGHT 3. NET PURCHASE PRICE TIME OF SIGN ° —96°F UNE a CHANGE • HOURS STATE PATROL VEHICLE FEE 5.LESS TAX PAD TO TE DATE OF TRANSFER TAX ✓ T D $ CHANGE I I TITLE/TRANSFER FEE 0 Q TRADE-IN WAS A MAKE - PLATE NUMBER - DATE - EXCISE TAX MODEL YEAR CHANGE EXPIRES LATE TRANSFER PENALTY CHANGE OF WGT.AND/OR CLASS SUB-TOTAL$ ..- c 1 ) THIS TAX IA NUMBER FROM ro. STATE/DEPUTY FILING FEE S1. -CT (NRA)D LEGALAGE.HAVE 90510.5B ISVEHICLE TOTAL DUE$ r THIS TAX CODE T TO LUIS SHOWN AND LE OTHERS.THIS BOUGH S Aro WILL CONTINUE TO ER INSURED WISE OPERATING UPON THE PUSUC STREETS ;� NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME DATE AND HIIGHIWAY&TIE VEHICLE WEL BE OPERATED N COMPLIANCE WITH THE LAWS WHICH APPLY TO ITS CLASS Of REGISTRATION,HAVE RECEIVED A COPY OF THIS APPLICATION AND ALL OF MY(OUR)DECLARATIONS . ARE TAE AND CORRECT.I(WE)RATHER CERTIFY THAT F TNS IS A COMMIE- II R L 4 CULL VSIECLC I(WE)HAVE KNOWLEDGE OmmERCIAL IE STATE AND FEDERAL MINNESOTA• J. L .� COUNTY DATE MY COMMISSION EXPRES u�CHAPTEER 221,TO U LI S COMM SION RUOPERANLESS 1 TI THROUGH , AND CODE OF FEDERAL REGULATIONS,TITLE 49,PARTS 390 • { - .� j - 399,AND F A TRANSPORTER OF HAZARDOUS MATERIALS,CODE OF FE.. , REGULATIONS.TITLE 49,PARTS 171 TO 199. , D� MINNESOTA DEPARTMENT OF PUBLIC SAFETY " fSIDNANRE(S)(ALL PURCHASERS OWNERS(S)MUST SIGN) DATE litb --ORNER AND VEHICLE SERVICES DIVISION,TRANSPORTATION BLDG" Ps 2000-,a 'NOT SIGN'UNTIL COMPLETED 395 JOHN IRELAND BLVD.,ST.PAUL,MN 55155 (612)-296-6911 TTY/TDD#(612)-297-2100 SELLER'S COPY INSURANCE IDENTIFICATION CARD OP ID TL STATE MN COMPANY NUMBER COMPANY THIS CARD MUST BE KEPT IN THE INSURED LMCIT-Berkley Risk Services, I VEHICLE AND PRESENTED UPON DEMAND POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE CMC16674 05/05/97 07/07/97 YEAR ( 4-9-7 MAKE/MODEL VEHICLE IDENTIFICATION NUMBER 1).9.6 Ford Crown 2FALP71W9VX167069 IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. AGENCY/COMPANY ISSUING CARD Obtain the following information: Landmark Insurance Services Landmark Insurance Services 1. Name and address of each driver, 612-464-3333 passenger and witness. INSURED 2. Name of Insurance Company and policy City of Oak Park Heiahts number for each vehicle involved. Mike Robertson, City Admin. 14168 N 57th St, Box 2007 Stillwater MN 55082 COVERAGE MEETS MINIMUM LIABILITY INSURANCE PRESCRIBED BY LAW 50 (1/83) INSURANCE IDENTIFICATION CARD OP ID TL STATE MN COMPANY NUMBER COMPANY THIS CARD MUST BE KEPT IN THE INSURED LMCIT-Berkley Risk Services, I VEHICLE AND PRESENTED UPON DEMAND POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE CMC16674 05/05/97 07/07/97 YEAR /117 MAKE/MODEL VEHICLE IDENTIFICATION NUMBER !'6 ord Crown 2FALP71W9VX167069 IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. AGENCY/COMPANY ISSUING CARD Obtain the following information: Landmark Insurance Services Landmark Insurance Services 1. Name and address of each driver, 612-464-3333 passenger and witness. INSURED 2. Name of Insurance Company and policy City of Oak Park Heiahts number for each vehicle involved. Mike Robertson. City Admin. 14168 N 57th St, Box 2007 Stillwater MN 55082 COVERAGE MEETS MINIMUM LIABILITY INSURANCE PRESCRIBED BY LAW 50 (1/83) Li 5/1 it e.,rill/ MAY - 61997 11 Landmark Insurance Services MEMO Page 1 PO Box 188 ACCOUNT NO. OP DATE Forest Lake,MN 55025 OAKPA-1 TL 05/14/97 Phone: 612-464-3333 Support: 612-464-7596 POLICY INFORMATION POLICY# CMC16674 TYPE EFFECTIVE EXPIRATION CP 07/07/96 07/07/97 City of Oak Park Heights Mike Robertson,City Admin. 14168 N 57th St, Box 2007 Stillwater,MN 55082 Mike or Judy, Re: Endorsement Enclosed please find the endorsement effective 5/05/97 which adds the 1997 Ford Crown Victoria to your policy. Please call us with any questions . Thank you. Sincerely, MAY 1 51997 Tracey Lund I'� ENDORSEMENT # ICITY OF OAK PARK HEIGHTS I CMC 16674 1 5/5/97 J COVERED PARTY COVENANT NUMBER EFFECTIVE DATE It is understood and agreed that the Schedule of Vehicles is amended as follows: Description Coverages wmi 1997 FORD CROWN VICTORIA #7069 ALL LIABILITY COVERAGES ACV $500. DED. COMP. $500. DED. COLL. grig POM E Total Endorsement Premium: $ 74. AP (See Below for Billing information) PREMIUM DUE NOW: $ (See Invoice Attached) OR x DO NOT PAY NOW PREMIUM ADJUSTMENT TO BE MADE AT EXPIRATION. All other terms and conditions remain unchanged. Executive Director, LMCIT LMCIT ME020(1/95) Page 1 of 1