HomeMy WebLinkAbout1996 Ford Crown Victoria Squad ArrULATIONTO TITLE/REG.
A VEHICLE PLATENUMBER YEAR FOR VAUDATION AND OFFICE USE ONLY
FOR CENTRAL OFFICE USE ONLY
YEAR VAUDATION STICKER NUMBER YEAR
C/.9'7' / P Al D
WEIGHT STICKER NUMBER , I 1
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969081 STUART BILL - _
TITLE TIRE REG. REG FR 'Famous PLATE NUMBER YEAR MONTH YEAR 07 Y T,r',.�i N4-+4 ^,,L}.
A 3 REG ONLY ONLY CHANGE EXPIRATION py�
DATE NON NE : E 1AS 7Q�'� CAR?
THIS COPY WIEN 1 I, ENTRAI ON T EY
PURCHASERS A DEPUTY REGISTRAR • WILL SERVE AS EVIDENd OF
PURCHASER(S) DATE OF PURL _ q CHECK �;A NATURAL GAS TAX PAID FOR THE PERIOD INDICATED.THE REGISTRATION PLATES SHOWN ON
OWNER(S) Z-- .. % NEW USED FUEL _OR PROPANE RECEIPT
LE DESCRIREV0.BEEN ASSIGNED TO THE OWNER FOR USE ONLY ON THE
MUST X TYPE DIESEL OTHER
COMPLETE MODEL YEAR MAKE BODY/MODEL TYPE u PLEASE CHECK IF THIS VEHICLE TRUCKS/TRAILERS: TRUCKS:
vehicle P. 96 FORD P71 CROWNVIC HAS BEEN PREVIOUSLY EMPTY WEIGHT NUMBER OF AXLES
information VEHICLE IDENTIFICATION NUMBER REGISTERED IN MINNESOTA
2FALP71W4TX146000 COLOR BODY ROOF
PURCHASER(S) CODE:
►UST,FIRST,AND MIDDLE NAME. -
OWNERIS) - DITHERS LICENSE NO./DEALER NO. DATE OF BIRTH
information CITY OF OAK PARK HEIGHTS
ADDITIONAL PURCHASER(S)OWNER(S)LAST.FIST,AND MIDDLE NAME(S) DRIVERS LICENSE NQ DATE OF BIRTH(S)
STREET ADDRESS CITY COUNTY STATE IP CODE I I
14168 57TH STREET N, PO BOX 2007 OAK PARK HEIGHTS e.:lif' jr? -MN 55082
►NAME OF INSURANCE CQ POLICY NUMBER HOME THEPFI)NE NO.
LEAGUE MN CITIES C(\'\c 1 y-7 I `5 (612)439-4723
ell
► IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? YES NC)( IF YES,COMPLETE SECTION BELOW.
•
FIRST SECURED PARTY(PRINT NAME) DATE OF LOAN
PURCHASER(S) I FOR ADDITIONAL SECURED PARTIES,
MUST) STREET ADDRESS aTY ATTACH COMPLETED FORM NO.PS2017.
OWNER(SSTATE - ZIPCODE
COMPLETE
CMILES(NO TENTHS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER (SEE WARNING ON BACK OF LAST PAGE)
► co
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
SELLERS) AND THAT TO THE BEST OF MY(OUR)KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE DESCRIBED ABOVE UNLESS ONE OF THE
MUST FOLLOWING STATEMENTS IS CHECKED.I(WE)THE OWNER(S)OF THIS VEHICLE CERTIFY THE VEHICLE IS fREE OF AU.SECURITY INTERESTS,WARRANT
TITLE,ASSIGN THE VEHICLE AND TAXES PAID TO THE PERSON(S)NAMED ABOVE.
COMPLETE
AND ❑ (I))HEREBY CERTIFY TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS
SIGN
0 (2)I 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
❑ HAS cioFNAS NOT(CHECK ONE)SUSTAINED DAMAGE IN EXCESS OF 70%ACTUAL CASH VALUE
► POLLUTION SY EM.DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THIS VEHICLE INCLUDING THE RESTRICTED GASOLINE PIPE
❑ HAS M HAAS NOT(CHECK ONE)BEEN REMOVED.ALTERED OR RENDERED INOPERATIVE.
P. > SRIOR FORD. INC.
PR MAWS)
SHLHPB S �LEs���1i`T`N AVE. N . � , ��� DATE
X / t/ CIA.�.t �4�-,�.1YM8U FH CITY MN 65442
STATE ]2P
SELLER'S '"F T:E(S) .e
D PURCHASER'S EXCISE(SALES)TAX DECLARATION BASE VALUE OR REGISTRATION TAX + $
01. GROSS WGHT
1.FULL PURCHASE PRICE......,... 19J PLATE FEE
PURCHASER(S) REGISTRATION PERIOD ARREARS TAX
OWNER(S) 2. ANCE
LESS TRADE-IN ALLOW
MUST COMPLETE
ITEM NO.
0 E N JA 'ROA" TO CONVERSION FEE
COMPLETEa NET 19550.1.00 CHANGE OF GROSS VEHICLE WEIGHT
PURCHASE PRICE W TIME OF
AND ,....-e)�� a_x of LINE 3
HOURSCHANGE •
• STATE PATROL VEHICLE FEE
S. LESS TAX PAID TO ANOTHER NET EXCISE TAX OTE $ N DATE
OF
I I TRANSFER TAX
TITLE/TRANSFER FEE (71. 0
6.TRADE-IN WAS A: MAKE PLATE NUMBER
DATE EXCISE TAX
MODEL YEAR CHANGE
EXPIRES LATE TRANSFER PENALTY f' /7
CHANGE CHANGE OF WCT AND/OR CLASS I SUES TOTAL$ ✓.,.'`
FROM To ✓
:
I DECLARE NSA STATE/DEPUTY FILING FEE ___i_47.)
THIS TAX I(WET CRETFY I(WE AM(ARE)OF TECTAL AGE,HAVE BOUGHT TIES VEMCLE •
EXEMPTION CODE T 1.0 LESS AHI ND OTAGE.TIKE VIUCLE IS APD Wu TOTALDUE
NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORECONTINUE TO N NSURED WHILE OPERATING UPON THE PUBLIC STREETS • $ / �+.'1 J
ME DATE AND HIGHWAYS,THE VEHICLE.WILL BE OPERATED N COMPLIANCE WITH +�`IF/ j fy//
THE LAWS WHICH APPLY TO ITS CUSS OF REGISTRATION,HAVE RECEIVED A
AVEACOPY Of THIS APPLICATION AND AU.Of MY(OUR)DECLARATIONS
ATRUE AND CORRECT I(WEITURTDER CERTIFY THAT F THIS B A ROGER-
_ .. CAL VEHICLE I(WE)NAVE KNOWLEDGE OF STATE AND FEDERAL REGULA-
COUNTY TONS APHIUEE TO COMMSICIAL WINKLE OPERATION MINNESOTA STAT-
COUNTY MY COMMISSION EXPIRES UTES,CHAPTER 221,PUBLIC REGULATIONS,
COMMBSDN RILES 1 THROUGH LB. A -
AND NODE T FEDERAL VORT R OFHAZARD U M 49,PARTS SPO `" .'.
SPP,AND FA IRANSPONETOFRAZARDOUS'MATERIAIS,CODE OF-�.: ,
REGULATIONS,TITLE IP.PARTS 171 TO 199.
IMPS * i \AKVI°4 ‹ ..."'`
MINNESOTA DEPARTMENT OF PUBLIC SAFETY SIGN: RE)'ALL•URCHASERS. NERS(S)MIST SI` DATE
DRIVER AND VEHICLE SERVICES DIVISION,TRANSPORTATION BLDG Ps.21H)018 DO NOT IGN UNTIL COMPLETED
A.OPPO.TWMHY RM0.GYNA 395 JOHN IRELAND BLVD.,ST.PAUL,MN 55155 (612)-296.6911
TTY/TDD I(612)-297-2100 PURCHASER'S COPY