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HomeMy WebLinkAbout1993 Chev. Squad Ntof MINNESOTA MOTOR VEHICLE REGISTRATION CARD RECORDED OWNER(S)RECORD OF SALE " A k PLATE TITLE PLATE NUMBER NUMBER G350002 00 NUMBER µ PLATES TAX TAX ITE EXPIRE BASE TNUMBLER G35000200 MANE CHEW MODEL YEAR 9 B'11CRTERYPE 40 CCL V.I.N. 1G18L5373PW110238 � G E 1618L5373P W11O238 NUMBER EXCISE TAX PAID ,yt� C TOTAL FEES PAID \T',. < E CITY OF OAK PARK-HIS BUYER'S SIGNATURES) SALE DATE ., < 0 14168 57TH ST N `'4• N OAK PARK HIS NN 55082-6409 STREET ADDRESS y'. E R ISI CITY STATE ZIP CODE ", I '' '..,•` . ' +S�1�Ar1 Dr yIIs T { SO1I 'I �1' ;y . S + , z CERTIFICAILEO ITCE ' _a r' ---'4,=.-- `` I-Cr Md1ROft-VEHICLE '� tf. .44 .3 ,,,.. +1 'Aa' a .A, ` THIS TITLE IS PRIMA FACIE PROOF OF OWNERSHIP '�. 7,( ' ti-F1. ., '.:KEEP IN A SAFE PLACE ANY ALTERATION OR ERASURE VOIDS THIS TITLE;^ q 4 16181.5373P W110238 1 CHEV 93 40 CCL \: EU VEHICLE IDENTIFICATION NUMBER ODOMETER MAKE YEAR TYPE 635000200 12/15/92 NEW 12/10/92 TITLE NUMBER DATE ISSUED NEW OR USED IF NEW.DATE OF FIRST SALE FOR CENTRAL OFFICE USE ONLY-- Ts9 NO SECURITY INTERESTS OWNER DOB 00000 i CITY.OF OAK PARK HTS w, 4 14168, 57TH ST N. \;; OAK PARK NTS MN 55082-6409 J_' 1 ApsieNjanay email ilivalrEkolu FEDERAL AND MINNESOTA LAW REQUIRE THAT YOU STATE THE MILEAGE INCTION WITH THETRANSFER OF OWNERSHIP.MINNESOTA LAW REQUIRES THAT YOU MAKE DISCLOSURES ABOUT POLLUTION CONTROLEQUIPMENT AND DAMAGE VEHICLE.PIVLTO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.SOME EXEMPTIONS MAY APPLY. ODOMETER DISCLOSURE STATEMENT,I(WE)STATE THAT THE ODOMETER NOW l'.DAMAGE DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE THIS READS (NO TENTHS)MILES ANATO THE BEET OF VEHICLE 0 HAS /}�� HAS NOT(CHECK ONE)SUSTAINED DAMAGE IN •N � • MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE. EXCESS OF 70%ACTUAL CASFI VALUE. x: DESCRIBED HEREIN UNLESS ONE OF THE FOLLOWING STATEMENTS IS CHECKED. KNOWLEDGE ' 0 (T) I HEREBY CERTKY TO THE BEST OF MY KNOWLEDGE THE WDMETER THE L SYSTEM hi TCeEOMH DISCLOSURE ON THOS VEHICLE KNCLuDIN°THE TEMENT TO THE BEST OF MY RESTRICED READING REFLECTS THE AMOUNT Of MILEMIE IN EXCQBf•OF•NT!=x�A- � MECHANICAL LIMITS. GASOLINE PIPE ❑HAS }/�-UISAS NOT(CHECK ONE)SEEN REMOVED, \\ 0 (2) I HEREBY CERTIFY THAT THE ODOMETER READING IS P&1TT}IE'ACTUAL. ALTERED OR RENDERED INOPERATIVE. \ MILEAGE. _ �, • 1 _ W ��.p_O}\M_�E�FTE�A DISCREPANCY IF BOX(I)OR.(EC)I�S`C^IAE(MED XSOIGNNMNITY(WE)-CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY , ARINING�ODDMETE _M I A.Ns=I�+� NYERES'15 WARRANT 14TLE AND ASSIGN THE VEHICLE AND REGISTRATION PAID TO: { (�et\-�_t�'I_�,.L�f,,=?. 08-13-98 SELLERS PRINTED NAME City of Oak ark Heights , DATE " PRmute .' 14168 57th St.N., Oak Park7C1�JIw„ 144 55082 I I C. BE STREET ADDRESS , MITERS AMMO TURFSBWER'B SHWA RE ) COMPLETE REVERSE SIDE . .I CIAAPI 1CAI FORTITI 111"Mtn PRINT BUYERS MIME NAME(E)LAST,FIRST,ALIO MWOL • \L__.... DATES)OF BIRTH .::,t. NiSTREET ADDRESS "'..j CAINIY STATE ZIP CODE /Y_ r 1 IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)X' NO 0 YES 0 ADDITIONAL ❑ IF YES,COMPLETE SECTION BELOW , , FIRST SECURED PARTY(PRINT NAMEH _. ). DATE OF SECURITY AGREEMENT \F I ' , STREET ADDRESS ABY STATE ZIP CODE ICNELREEY ISOARRDECRUAL NAME Of HOLEY )MURINCa NUMBER COMPLETE AND ATTACH EIWSEaI COMPANY I(we),certify I(we)am(are)a)legal age,have bought this vehicle autism Is bents shown and no odors,this vehicle le and WE contexts to be Warred while operating Won the It.% r public streets and highways,and aB d my(our)dedMMlorla ats true and coned X , �v BUYERS SIGNATURE(11)ALLBUYERS SKIN. BUYER'S DRIVER UCENBE NUMBERS) ,.,"/(z). .2,- 9'• 3..._ 1,1 _ .. ,. ......ez., , 1/ri ":) ,, I i ko ;rn CO yz f `w * I* }.0o l �dVsy(� �f°e � ``sr1", d w O rr ,D p ,: rip.. g 4,, .,,,, 0 1. .. iI t,,h ,,,;,,i>' '". ,- --.' l' ' ' .''' 1-1 (D Z ! i i/ iyy?ii $4. 1: 5i. tiiitC . .r S 1 { lr Y {a c:. Q• -1.', ''a 1 ' I " ;;;401 ','-,,c.,:', :y;-1.i.,: ,_.,,)1",ii...iiii; lii I ' - ' � ' ` � � h �,4 coir i! '' '-.i'--•,:-• '',..•. '1 'iii*'�" : w 1,. , _ 1-) Ul �' - z t V'1 � qt ` y' $� *,1 8a± o a t2 tx&£ y▪" Ul asp �' r® i ''''''.';'1, . .', ", i �Y▪y 1 , ? . .cn,-1/4o .p Ow t,, m- c-.4rn Po;vcvi �'u I�/RRE ONLY VEHICLE PLATE"UMBER _ YEAR FOR:VAIDATION ANDgICE USE ONLY 4 aR! USE i�/cam• �� rff�} hile STICKER NUMBER YEAR A 0 Er' riail dr/ DEC101992 .TETLE TITLE REG REG TFR PREVIOUS PLATE NUMBER YEAR MONTH YEAR 8 REG Y ONLY CHARM EXPRATION {{-- y�y p i1. A DATE C?L:74.?!' R ( STi1AR#65 PURCHASER(S) DATE PURCHASE NATURAL USED FctlEck UEL noon* e ORPROPANEATE ;e+.,i,y i"..." "/�Q _ ,001k TYPE I oESEL oTHEa� MUST COMPLETE MODEL YEAR MAKE BODY/MODEL TYPE 07 ,i� � /� NON�OT'IA W IIGISIRATION RECEIPT(CARD)ABO CAB CARD V811-EIB ► /g9`./ . i j -3' l'7�� THIS COPY WHEN VAUIMT®(STAMPED ON THE COIMIERI COW:,G/ L/' A DEPUTY REGISTRAR OR THE CENTRAL OFFICE,WRL SERVE AS EVIDENCE OF IBIfOTOIatiOLt VEHICLE IDDEEMFRCATTON NUMBER TAX,(��j�J /, /���0� J'� I THIS RECENT NFOR AVE BEBJ ASSIGNEDPERIOD THE OWNER FOR LSE OILY ONN 11* ON /6/3L5375 /- ""�" //'�'"/14/OCODE EOD ) � VEHICLE DESCRIBED. PURCHASER(S) ►LAST,FIST,AND MIDDLE NAME DRIVERS LICENSE NO. DATE Of BIM IBfD ion � ® && .c- . ./42.04.1161,e �."‹.#/.1 I ADDITIONAL )OWNER(S)LAST,FIRST,AND MIDDLE NAME(S) DRIVERS UCE15E NCL DATE OF BRTH(S) I I STREET ADDRESS CITY C•0011, .. STATE 2P CODE 0/ iG.01 . ;rte, ...ter 4,'. a9,1� '%eI• s DV F. "et-- ..•s. a NAME OF INSURANCERyAjPICF CG F«1CY NLHMBER _TELEPHONE NO. ► _./;/ '`'&Y1 ''/' /i/4/ ,/ - 7(//'/1:-. -''-'0''. ',e,.✓ ,/.. %'5 ' - B ► IS THIS VEHICLE SUB9ECT TO SECURITY AGREEMENT(S)? YES NO be." IF YES,COMPLETE SECTION BELOW. FAST SECURED PARTY(PENT NAME) DATE OF LOAN PURCHASER(S) OA'5(S) STREET ADDRESS CITY STATE EP CODE MUST COMPLETE LOAN SECOND SECURED PARTY(PRINT NAME DATE of LOAN FOR ADDITIONAL SECURED PARTIES, Information ATTACH COMPLETED FORM NO.PS2017. STREET ADDRESS CITY STATE ZIP CODE MILES(NO TENTHS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER (SEE WARNING ON BACK OF LAST PAGE) RAI(WE)THE OWNER(S)OF THE VEHICLE DESCRIBED ABOVE,CERTIFY THE ODOMETER ON THE VEHICLE NOW READS THE/ALES AS SHOWN ON THE LEFT AND THAT TO THE BEST OF MY(OUR)KNOWLEDGE THAT R REFLECTS THE ACTUAL MLEAGE OF THE VEHICLE DESCRIBED ABOVE UNLESS ONE OF TIE 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 0 (1)I HEREBY CERTIFY TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING REFLECTS THE AMOUNT OF MLEAGE IN EXCESS OF ITS MECHANICAL LIMITS AND SIGN ❑ (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 ❑ HAS NOT(CHECK OPE)SUSTAINED DAMAGE IN EXCESS OF 70%ACTUAL CASH VALUE. P. POLLUTION SYSTEM DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THS VEHICLE NCLUDNG THE RESTRICTED GASOLENE PIPE 0 HAS ❑ HAS NOT(GEC(ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE. P. SELLERS PRINTED NAME(S) DATE SELLERS STREET AMRFSS CITY STATE DP X SELLERS SIGNATURE(S) - D PURCHASERS EXCISE(SALES)TAX DECLARATION BABE VALUE OR REGISTRATION TAX+ $ a $ It CROSS WONT. PLATE FEE 1.FULL PURCHASE PRICE PURCHASER(S) 2 LESS -IN OW REGISTRATION PERIOD ARREARS TAX ALLANCE O INERm COMPLETE ITEM NG 6 FROM TO CONVERSION FEE MUST CHANGE OF GROSS VEHICLE WEIGHT COMPLETE 3.PFT PURCHASE PRICE TIME OF AND CHANGE • MO1� TRANSFER TAX SIGN 4._%OF UNE 3.. 6 5.LESS TAX PAD TO ANOTERE STATE DATE OF TITLE/TRANSFER FEE eR QY NET EXCISE TAX RUE $ a CHANGE I I EXCISE TAX 6 TRADE4N WAS A: MAKE PLATE NUMBER DATE LATE TRANSFER PENALTY 6100E YEAR EH AM I I SUB-TOTALS a CHANGE OF WGT.AND/OR CLASS STATE/DEPUTY FILING FEE 3 .311 NUMFROM .. TO THIS LARE A NUMBER - TOTAL DUES a / 1(WET CBTFY I(WE)AM(ARE)M LEGAL AGE.HAVE!OUGHT TR WHOP 51) EXEMPTION CODE / C.2 SUWECT TO LENS SHOWN AND NO Mee INS VEHICLE IS AND WILL3 NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME. DATE CO NGHIME 10 E FORMED H w1e,E OPRGTNO UPON Pi THE COMPLIANCE STREETS CO NOH WAYS.IAP VEHICLE HILL BE OPERATED N 16 PUNIC WIRD TE LAWS WHICH APPLY AI ITS CLASS M R P MV(OLE)HAVE DECLARAet#9 TIONS A COPY O'THS APP UATON AID ALL OF MY(OUR)DECLARATIONS i- if ALE TOE AND CMRFCL I(WE)FURTHER CERTIFY THAT F TNSLS A COMMA- C141 CWNW 1(WE)HAVE KNOWLEDGE M STATE AND FOAL REGLM- MINNESOTA ST . COUNTY DATE MY COMMISSION EXPRES DIES,DOWr 1PPUCAILETOMMERCIAL mIC .PuC C�OW/3551ON ROPERAULES I TNIOUGH 1*. XJ„m '/ f . i 7/.... a AND CODE OF FEDERAL REGULATIOWL TIME 49,PARTS 390 THROUGH 399.ANDF A TRANSPORTER OF HAZARDOUS MATERALS,CODE M FEDERAL REGIMTION5,TITLE 49.PARTS 171 TO 199. SIGNATURE(S)(ALL PURCHASERS• .• MUST SIGN) DATE itMINNESOTA DEPARTMENT OF PUBLIC SAFETY D DRIVER AND VEHICLE SERVICES DIVISION,TRANSPORTATION BLDG PS 2000-I5 DO NOT SIGN UNTIL COMPLETED A»EDW.,G..O.RWH,n EMPLOYER 395 JOHN IRELAND BLVD.,ST.PAUL,MN 55155 PURCHASER'S(OWNER'S COPY) TO TITLE/REG.A VEHICLE PLATE"AMER ' , YEAR FORYA1R1MllunNv _._. .ENTRAL OFFICE USE ONLY. "// STICKER NUMBER C" 'TEAL` ✓f t i LI I , hh . MONM YEAR 4 11..�i I' i, � t�� % IDLE TITLE REG REG TER PREVIOUS PLATE NUMBER YEAR ' 1:4 .. A3 REG I Ot I OPLY `OWx'E I ,rj/( �+ EXPDATE IRATION . PURCHASER(S) DATE of PlIR01ASE aI NEW I Al I USED I Il P WNER(s) /.;.;°/.;.;° .+r� 9,,,0:4+� BODY/MODEL TYPE - MUST Anon YEAR E/ COMPLETE-vehicle ► 3 I MAKC_. // L '/„/fi�/''. IEEformm1abbaR vE1RaE yearic VpNNI1MBEIt -y r� /,r //'''..=)/5,/= , / ,r ROW -- ROOF /h / Z. l/' ✓ /�C L. -'//!. ✓./5Jc.OUc DRIVERSIGHl5E N0. DATE OF 1111TH,.. .p1lIIC1USER{5,.. UST,flST.ANo MIDDLE NAME - .!`) nfo tion r //. /''l`.' t. ).ee r''/. ''i ,..0":1/A .Nn LUTE aF I ADDBIONAL PIR (S)OWI'RR(S)LAST,FRST,AND MIDDLE NAME(S) I orY couyr SPATE Zr CODE STREET ADoaEss, _ d GG 11 /1 I ./r l/ -.,:' -=' '..C'./; :.�.. �' , . ti-; /.e' /11.-�' 1'f/ j.I Aire(_ . ., NAME of INSURANCE OS 1.- IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? YES I NO, L IF YES,COMPLETE SECTION BELOW. B (DATE OF LOAN FIST SECURED PARTY(PRI NAME) PURCHASER(S) r r CODE ICITY OPlP6tR) SIREEi ADDRESS MUST COMPLETE of LOAN I FOR ADDf TIONAL SECURED PARTIES, SECOND SECURED PARTY(PRI NAME) IDAYE ATTACH COMPLETED FORM NO.P52017. STREET ADDRESS Ick inLOAN formation rATE rCODE - OF MILES(NO TENTHS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER(SEE READSTHE VEHICLE NOW SBAAS LAST C 1, I(WE)THE OWNER(S)OF THE VEHICLE DESCRIBED ABOVE,CERTIFY THE ODOMETER ION 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 CERTFY 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 N EXCESS OF ITS MECHANICAL LIMITS. AND SIGN ❑ (y)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 0 HAS NOT(OIECK ONE)SUSTAINED DAMAGE N EXCESS OF 70%ACTUAL CASH VALUE ► POLLUTION SYSTEM DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THIS VEHICLE INCLUDING THE RESTRICTED GASOLINE PIPE ❑ HAS ❑ HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE D. DATE SELLERS PRIED NAMES) NAMES) STREET ADDRESS / CITY STATE ZIP X SELLER'S SIGNATURE(S) BASE vALUE OR REGISTRATION TAX+ $ ¢ D PURCHASER'S EXCISE(SALES)TAX$ ECLARATION C GR05s WWII PLATE FEE 1.FULL PURCHASE PRICE REGISTRATION PERIOD ARREARS TAX PURCHASER(S) 2 LESS TRADE-IN ALLOWANCE ICE FROM TO CONVERSION FEE OWNER(S) COMPLETE ITEM NO.6 MUST CHANGE OF GROSS VEHICIE WEIGHT COMPLETE 3.NET PURCHASE PRICE TIME OF HOlIS TRANSFER TAX CHANGE • AND A._%OFTRW 3... TITLE/TRANSFER FEE d'Tl SIGN 'FRES- S.LESS TAX PAD TO ANOTFfR STATE DACE I I EXCISE TAX NET EXaSE TAX DUES ¢ 6.TRADER WAS A; PLATE NUMBERLATE TRANSFER PENALTY MODEL YEAR MAKE DATEOIANGE E I I SUB-TOTAL$ ¢ CHANGE OF WGT.AND/OR CLASS STATE/DEPUTY FILING FEE 3 FROM 70 TOTAL DUE$ I DECLARE W.NUMBER - _ /^� IIW�®fIFY� IAM aurAL AOEIIAYETOI1cI1T T16 veRCIE THIS TAX El ECT TO IB6$ N.Aro No ORBS.TES VEHICLE R ALUMS �,.. COMET 7 TO of maw WIRE CTUATN6 IES DE KIRK 511@775 EXEMPTION CODE AND AWS WHIC IAP VEHICLE WLL a 09aATED AT CN.HAVE OL WITH ED .. NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME DATE WE LAWS WHICH APPLY 70115 QA58 OF BA1W IOION HAVE .� — A COT'OY 7IIR MPRCAOE)F Aro Au OF AZTROLE) 15ACOTEXE 'r ,1_��,!L GALVEEAND CHA (WE)WLEDGE OLIWFTIERACOMEIH- ,. r CUL VEHICLE I(WE)RCE RVIOWIEOOE OF STATE AND FEDERAL REC#RA- _.r W.� F� �../ �j um4 CHAPTER ID PUNIC s a CCMAOYDU mums 1 111OIK71 //.� /�� DATE MY COMMISSION EXPIRES APO COOL O EFED RAL IAM CO,TITLE 9 PARTS 290 11411OUGTI V COUNTY 399,AND AF ,RAPRORIOOFNAUB!%RnBMA7EdMSCOGEOEOff®ERAL A REGULATIONS.1T115 49.PARTS 171 TO 199. SIGNATURE(S)(ALL' .,•7 r. • ::r MUST SIGm DATE topMINNESOTA DEPARTMENT OF PUBLIC SAFETY - DO NOT SIGN UNTIL COMPLETED DINER AND YEHN]E SERVOS DIVISION,TRANSPORTATION BLDG SELLER'S COPY PS 2000-15 a„Ta 395 JOHN IRELAND BLVD.,SL PAUL,MN 55155 TEAL # 146 Thune,Howkins ADVERTISING CUSTOMER # 287166 DAVE THOMAS mPE) It • .. _ SALESMAN (NAME). 1 • a r Chevrolet GED MQzda, i nc. DATE 12/10/92 STOCK# 32412 - 1801 E. Cty. Rd. F WHITE BEAR LAKE, MN. 55110 (612) 429-7791 LEAGUE OF MINNESOTA CI INS CO. POLICY# CNC 12802 BUYER'S CITY OF OAK PARK HEIGHTS CO-BUYER NAME NAME BUYER'S CO-BUYER'S DRIVERS LIC.# DOB DRIVERS LIC.# DOB STREET 14T68 — SZTI' STREET NORTH RESIDENCE ADDRESS PHONE CITY,STATE OAIN PARK HTS WASHINGTON MN 55082 BUSINESS COUNTY,ZIP PHONE (612)439-4439 PLEASE ENTER MY ORDER FOR A C 93 CHEVROLET cA CAPRICE 4 DR SEDAN DEMO (YEAR AND MAKE) CK (MODEL) (BODY TYPE) LICENSE COLOR BODY SPECIAL COL( OF TRIM BLUE CL/VN SERIAL NO. 1G1BL5373PW110238 CASH DELIVERED PRICE OF UNIT $ NON u • k IALLED OPTIONS $ FREIGHT PO # L SI ANSON OPTIONS AS PER WINDOW STICKER ) ,— BILLING INVOICE TOTA -- . e , $ 13074.00 TRADE IN YR. N/A MAKE N/A MODEL AND EQUIP. TRADE IN ALLOW.AND DISC. $ NONE BALANCE $ 13074.00 LOCAL DEALER HANDLING AND ADJUSTMENTS $ INCLUDED RUSTPROOFING YES NO XX $ PAINT SEALANT YES NO XX $ FABRIC PROTECTOR YES NO XX $ BALANCE $ 13074_00 SALES TAX 14/44 $ $49.-81-- LICENSE $ NONE DOCUMENT ADMINISTRATION FEE $ t4= .v=Ma RECORDING/TRANSFER + CERTIFICATION— FEES $ t.'� BALANCE $ 13923.81 K; 1i')XgATE DPS n/ , $ 04.01 SERVICE CONTRACT YES NO $ ?low Transferor(Dealer)hereby certifies,to the best of his/her knowledge,that the pollution- DUPLCATE TITLE FEES $ X9�'3�Y,XX control system on this vehicle being sold, including the gasoline pipe, has not been BALANCE DUE ON DELIVERY $ 13074.00 removed,altered,or rendered inoperative. DEALER'S DISCLAIMEROI WARRANTY .The Dealer expressly disclaims an warranties, either express or implied on the vehicle sold, except any warranties offered and explained in Paragraphs 10 through 13 on the back of this contract. Buyer acknowledges receiving this information before'the sale and further acknow= v�Vn1,�\ ledges having read and understood the provisions on the back of this contract. r C OMER SIGNATURE 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 ONTRACT were agreed •on and the CONTRACT signed in this IMPORTANT: THIS MAY BE A BINDING CONTRACT AND dealership on the d - noted at t•• of this fo . If 'EALER is arranging credit for YOU, this CONTRACT is i/id (til a e.'t disclo- re iy' ade as described in Regulation Z and you FOR MAY CORE ANY DEPOSITS IFR YOU U NOT PERhave acceptedreexte•de•. J FORM ACCORDING 0TS TERMS. CUSTOMER SNOTICE OF SAAN' LI IT' r AUT ► 1YYcontract is not valid unless signed and AUTHORIZES DEALS- 0= INA CONSUMEaccepted by Sa :• • i. f De. :r CREDIT REPORT IN C/ �I �t ��f.�/ OF THIS VEHICLE. N IT' THI FINANCING Accepted QCT t Nip � Buy-r's i atureAcc-• ng erms of Contract This ODOMETER DISCLOSURE STATEMENT and ASSIGNMENT Refers to Vehicle Being Sold Federal and State law require that you state the mileage upon transfer of ownership.Failure to complete or providing a false statement may result in fines and/or imprisonment. I(we), THANE HAWKINS POLAR CHEV.GEO MAZDA.INC. ,the owner(s)of the vehicle desgibed below,certify the vehicle is free of all security interests, Transferors Name Print) 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. El (2) I hereby certify that the odometer reading is NOT the actual mileana [Witt. Thr,ne Howkins ADVERTISING � CUSTOMER !k 2.87166 PAVE; T}IOt!A S inner • • Ir Chevrolet Gee Mazda, Inc. DATE SALESMAN 1/412 (NAME) 12 0/^% STOCK# 1801 E. Cty. Rd. F WHITE BEAR LAKE, MN.55110 (612)429-7791 I,F.ACUI: (`r i,'lr,;r�(' ^ ' t' INS CO. POLICY# C7'r: I'.)P)2 BUYER'S CITY OF OAK PARK HEIGHTS CO-BUYER NAME NAME 'I. BUYER'S CO•BUYER'S DRIVERS LIC.# DOB DRIVERS LIC.a DOB STREET 14168 - 57Th STREET NORTH RESIDENCE ADDRESSPHONE CITY,ST,ZIP OAK PA" PTS WASHINGTONMN 55082 BUSINESS 612)43^-643' COUNTY,ZIP ( ) - PHONE PLEASE ENTER MY ORDER FOR A 93 ,CHEVROLET eap CAPRICE 4 DR. SEDAN DEMO (YEAR AND MAKE) ,T' K (MODEL) (BODY TYPE) LICENSE COLOR BODY SPECIAL. COL ROOF TRIM BLUE CL/VN SERIAL NO. 1G1BL5373P17110238 CASH DELIVERED PRICE OF UNIT $ NONSISA1ACAL4Y-INSTALLED OPTIONS $ FREIGHT PO it L CWANSON OPTIONS AS PER IrTNOM! STICKER, PILLING INVOICE -TOT $ 13U74.ra> • TRADE IN YR. T)/A MAKE N/e • MODEL AND EQUIP. TRADE IN ALLOW.AND DISC. $ NONE BALANCE $ 11074.0i> . LOCAL DEALER HANDLING AND ADJUSTMENTS $ INCLUDED RUSTPROOFING YES NO XY S PAINT SEALANT YES NO Yn S FABRIC PROTECTOR YES NO Y!r S BALANCE 1 $ 11074_r": SALES TAX N/A $ • +,* LICENSE S '•t("'r DOCUMENT ADMINISTRATION FEE S �'r,r.' , RECORDING/TRANSFER+CERTIFICATION-FEES S ►P.90\;;! BALANCE c S 1382'1.'1 � T sgATR UPS Mf3� s t'6",t'1 SERVICE CONTRACT YES NO /T S rffyq; DUPLICATE TITLE FEES S Mar -' Transferor(Dealer)hereby certifies,to the best of his/her knowledge,that the pollution - control system on this vehicle being sold,including the gasoline pipe,has not been BALANCE DUE ON DELIVERY $ 13071,..-., removed,altered,or rendered inoperative. DEALER'S Of$LAMER OF,WARRANYY The Dealer expressly disclaims all warranties either exprges or,imptled On the vehicle sold, except any warranties offered and explained in Paragraphs 10 through 13 on the back of thIs C OMER SIGNATURE contract.Buyer acknowledgesml receiving this lnfoatiort.before the MM and further aoknow- .� }LiiVY� r s JC�— ledges having read and understood the provisions on.the back of this contract — — ,... 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 ONTRACT were agreed ion and the CONTRACT signed in this IMPORTANT:THIS MAY BE A BINDING CONTRACT AND dealership on the d4 noted at t••of this fo .I •EALER Is arranging credit for YOU,this YOU MAY LOSE ANY DEPOSITS IF YOU DO NOT PER- CONTRACT is not Id rail a -•t disclo re I''ade as described In Regulation Z and you FORM ACCORDING 0 TS TERMS. CUSTOMER(S) have accepted ih •reiexte••••. NOTICE OF SAL:-•.-.e N'- , IT a •UT I ',iris contract is not valid unless signed and AUTHORIZES DEALS-= ' • L r 0 ,IN A CONSUMER accepted by Sal: �� . : De %Z. CREDIT REPORT IN "', • +e TH FINANCING ' ����� �, /'// OF THIS VEHICLE.) 1 ,! i , I 5t;�_ Accepted X, A ♦I Buy-i s I. elute Acc-• ng •rms of Convect This ODOMETER DISCLOSURE STATEMENT and ASSIGNMENT Refers to Vehicle Being Sold • Federal and State law require that you slate the mileage upon transfer of ownership.Failure to complete or providing a false statement may result in lines andlor imprisonment. I(we), THANE HAWKINS POLAR CHEV.GEO MAZDA.INC. ,the owner(s)of the vehicle described below,certify the vehicle is tree of all security interests. Transferor's Nanny Print) ) 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, (t)I hereby certify to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. 0(2)I hereby certify that the odometer reading is NOT the actual mileage. WARNING—ODOTiAETFI,D f P N l�d box( or Pis checked. YEAR-. ;;;'P.. - &WI i Y �r,.' ,.4lank f .BODY •TVP ' 4 ' CHEVROLET", • (APR/CF: 4 6R SFPAII VIN. -LICENSE NG. LIC.EOP.DAT �a5y3� P,W o23f j'� ; T TJI�'��R' 'ItP2CNTS TRAN E-••' ('ELLER) TRE r.F �1 STRE T S Ct ( SGTE a �1�igDg - 57TH STREET NORTH �k, I i. f / MN 55,to CIiv OAK PARE HTS STATE UN ZIP 55082 T_�� �;•*y�i E' ',rN ,�jIGNERS NAME ALSO) TRANSFEREE'S(BUYER)SIG U R T NE Altfl _y z - ,�I �/I STATEMENT DATE Rece,pl of copy acknowledged �/ .SACK {3.-� 1?/]rt/92 r•I I IaS.rAI TVI 1 I V I I I eeA./HikeV.I'1 P VI CE11\ LL 2 ..-FOR CENTRAL OFFICE USE ONLY //J, %(7' C/ 1 �j it J U l JJj; ZJ r - t STICKER NUMBER YEAR " -1-\" • - 1, 0 1f) :TIRE TITLE REG REG TFR PREVIOUS PLATE NUMBER YEAR MONTH YEAR A 8 REG Or ONLY ouNDE EXPIRATIONr �-!/ (LATE x:17&: \:' >-71._r,.;.,31-,J 1 fl A -#66 PURCHASER(S) DATE OF PURCHASE CHECK Guam* Ore AIS lDEAL ._ )D`NN,i OWNERS) �� ��- ' //� NEW _ USED TYPE ( ORSEL ODES MUST MODa YEAR MAKE BODY/ASE TYPE 07 COMPLETEy1 //'��G //J'.�`J NON-PDOOrunE RRRDIRATION INCEPT(CARD AND C fB CRD ► // �� vJ�/` y U/G� STAA•dPED ON NE UPPER NWT AMDEPU R OR WHEN VALIDATED CEt/1RAl O WILL SERVE As EVIDENCE OF ilRfOflRTOti011 VHICIE DBTI�ATION NR1MItR TAX PAD FOR THE PERIOD INDICATE%DE REGISTRATION PLATES SHOWN ON �/J THS RECEPT HAVE BEEN ASSIGPED TO THL OWPIE FOR USE OILY ON TFL /6/��G�3 73 �"`2 // ...7. 4'CODE: BODF) ROOF VEHICLE DESCRIBER PIROIASSSIS) ►LAST.FEST.AID MEOW NAME DRIVERS UCDLE NG DATE OF NRHI information ®f age /' 4Z ADDI110NAL )O PRR(S)LAST.PEST.AND MIDDLE NAMHS) DRIVERS LXH'ISE NO. DATE OF BRIARS) STREET ADORESBCITY Gf/1( STATE VP coOE /yiAg .s7-4/4. •-.7, ,like © .e #e, fj.... //e., ,5.›-Drz..- TWA!or NCE co. • ► .,�/�/ ,r< 2', 1/f/ , ' 7-i;://-, POLICY IRRM9t C,/'//! ,./-'7%l e . .(-0,',7.013 ► IS THIS VEHICLE •ECT TO SECURITY AGREEMENT(S)? YES I NO /I IF YES,COMPLETE SECTION BELOW BDATE OF LOAN fRST SECURED PARTY mon NAME) PURCHASER(S) WF EES) STREET ADDRESS pry STATE - ZIP CODE MUST COMPLETE SECOND SECLLR®mart prom NAALE) DATE OF LOAN IOAN FOR ADDITIONAL SECURED PARTES, information ATTACH COMPLETED FORM NO.PS2017. STREET ADDRESS CRY STATE LP CODE C0. MILES(NO TSS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER(SEE WARNING ON BACK OF LAST PAGE) I(WE)THE OWNER(S)OF THE VI3NCLE DESCRIED 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 Cf THE VEHICLE DESCRIED 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 HNTERESTS,WARRANT MUST TITLE.ASSIGN THE VEHICLE AM)TAXES PAD 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 0 (2)I HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE WARNING-ODOMETER DISCREPANCY IF BOX(1)OR(2)1S CHECKED. ► DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THIS VEHICLE❑ HAS 0 HAS NOT(CHECK ONE)SUSTAINED DAMAGE N EXCESS OF 70%ACTUAL GSH VALUE ► POLLUTION SYSTEM DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THE POLLUTION CONTROL SYSTEM ON THIS VEHICLE NCWDFIG THE RESTRICTED GASOLHE PIPE ❑ MAS ❑ HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE P. SamsSamsPANTED NAMES) DATE HELENS STREET ADDRESS CITY STATE a X ES M'S sKHNATURE(S� PURCHASER'S EXCISE(SALES)TAX DECLARATION BASE VALLE OR REGISTRATION TAX+ $ t D $ < GROSS wGla PLATE FEE 1.PUL PURCHASE PRICE REGISTRATION PMI ARREARS TAX PURCHASER(S) 2 LESS TRADE-IN ALLOWANCE OWNER(S) COMPLETE ITEM Na 6 FROAL TO CONVERSION FEE MUST ORANGE OF GROSS VEHICLE WEIGHT COMPLETE 3.NET PUR LASE PRICE TYRE OF AN) /L ORANGE DOMSIGN _SLR- OF R 3../644, • TRANSFER TAX D M S.LESS TAX PATO ANOMER STATE DATE OF �LE/,RA SER FEEA en PET OBS TAX DUE $ IL CHANGE I I EXCISE TAX 6.GRADE-I+WAS e; MAKE PLATE NAL DATE LATE TRANSFER PENALTY Mona YEAR CHANGEEXPEES I ( SUB-TOTAL$ ORANGE OF WGT.AND/OR CLASS STATE/DEPUTY RUNG FEE • 3 56 FROM TO I DECLARE 113 NLLAEeFR TOTAL DUE S //7/• f< TILS TAX. / I(MU ODIFY I DVEU AM RAR)or LEGAL Actium footmen ns venal ./ J V woe DE SUBJECT TO IBE MOWN AID NO 01195.lis MALE 6 AID WA CONIELI TO s NAPA WIRE OHRATND VON THE AMC STREETS NOTARY SIGNATURE SLR AND SWORN TO BEFORE ME. DATE AND 1101 AY&TM V69CO WEl EE ORATED N COMPLIANCE MINI THE LAWS WADI APPLY TO ITS 0ASS OP UG6TEATIDM NAPE REC6YID A COPY OF no ATRIUM GN AM ALL OP MY(OUR)DLCU1ATION6 ,•I ME TGE AID COAMCI!WARMER CAW TINT F MS 6 A COMMD- 67)/4.) • 001.VEI50E 1 HAVE KNOW1®DE OF SLOE AID 1®RM U0UA- 1106AFPIICAIIETOCOMNACMlV6ECILQ®A141A NSdG$GT- - 7/-N a COUNTY DATE MY COMMISSION EXPRES VES 0441101 331,MDC SERVICE COMPASSION SAES 1 THROUGH.M AND CODE OF MBA REGULATION.1111E M.METS 390 THROUGH 399.AND F A TRANSPORTER Of IULLARDOIS MAMAS.COOEOF R06RAL DOULATIOP6,TDUL 49.PMTS 171 TO 199. SIGNATURE(S)(ALL PURCHASERS MUST SIGN) DATE R DPS MINNESOTA DEPARTMENT OF PUBLIC SAFETY DO NOT SIGN UNTIL COMPLETED DRIVER AND VEHICLE SERVICES DIVISION,TRANSPORTATION BLDG -,R,�,,,,o, 395 JOHN IRELAND BLVD., z000 1s,Si PAUL,MN 55155 PURCHASER'S(OWNER'S COPY) FOR CENTRAL OFFICE USE ONLY i /.... i / 4<-6- . STICKER NUMBER D.A. . . DIE ME REG REG IFR PREVIOUS PLATE NUMBER • YEAR MONTH YEAR LiFe I 0 Q - • 199 - A .REG Or Y ONLY mum '''/..1-1: DONATION DATE C# - ;;',V PURCHASER(S) DATE DE EDEthASE 0DT:x „um, u.,NATURAL GAS • „r-:,,::, ,.., NEW k. USED HEL I -X_DE EDOPAEL I_ '.. • IT-4 .-.'.1 r,•,,, .. A OV,04215) ,...• -.,e2 - TYPE DDSS OINSt —' - • : :,.';',!‘;`,--,;, ''-' MUST COMPLETE MODEL YEAR MARE LIODYNIODEL TYPE • . .. .• vehicle' ii. /993 61.7)./rite.., . ••<//-:•)/‘",- .. • • /C.-*//3 Z,.5-..3 73 /6 7‘.6-.'// • = . . , IW ' . INLINNetione.,ARcmOI6IL,44;. or,- e2,./.e /-1.1,/-l.e- I /4 /z's . --- . - - ,., 1.- . - ..-. I . ' : -I A. ON ; •,.. • • .. sTATE acme - . . ....- .. --....,• . .. _ .*-5--7--e,e-- J/ /6/- atfe ./4'A . e.cc119/4W 1.1-2— .1;!f• - —<.&rrte-. „ ;• .- NAME OP MISURANCE 02 • - .-, POUCY NUMMI -- , or Eta-• '''''• ' ., .(r3e.,-4,e.•/.7 ,,`'/. ././,' .= • /-1/---/../,',. • . liii"X-,=;--'''--'.." - - - . F _ Ad . '.-. . ...,V ill' ' IS THIS ViiHICLE suftecT TO SECURITY AGREEMENT(S)? ' -- YES I ::'I.NO 61F YES,COMPLETE SECTION BELOW ' - : ‘•- : - -''..!'' B NW SEWED PARTY RINT HAIM • DATE OP IOAN . .... . . . PURCHASER(S) • - .. • - - . .. • . . . . • =Er Atoms - MUST "- • lOAN SECOND SECURED PARTY(PPED NAME) ' • ,,,. . - FOR mum&omoREO FARM DATE OF EOM • ' Information • - ' ATTACH COMPLETED FORM NO.PS2017. ' SWEET ADDRESS ON - STATE • . . . .• C MUS(N°TENTHS) ' • ODOMETER STATEMENT AND ASSIGNMENT BY SELLER(SEE WARNING ON BACK OF LAST PAGE) 1. - ' I(WE)GE OlevNER(S)OF GE vaiCIE DESCREED ABOVE.wow DE ODOMETER ON THE mow NOW READS TIE MIRE AS MOWN ON TIE ISTT - ' AND THAT TO THE BEST OF MY(O(t)KNOWLEDGE THAT II REFLECTS THE ACTUAL MUNN OF DE VEHICLE DESCRIED ABOVE UNLESS ONE OF TM SELLER(S) . FOILOWNG STATEMENTS IS OEOCEIL I(WE)THE OWNER(S)OF THIS VEHICLE CERTIFY TIE VEHICLE IS FREE OF ALL SECURITY 01TEMISTS.WARRANT MUST V TITLE,ASSIGN THE VEHICLE AND TAXES PAID TO TIE PERSOFKS)NAMED ABOVE. - COMPLETE 0 (1)I HEREBY CERTIFY TO TIE BEST OF MY KNOWLEDGE TIE ODOMETER READRIG REFUM THE AMOUNT or MIRAGE IN EXCESS CF ITS MECHANCAL uvars . AND SIGN . 0 (2)I Hem a$Tr(THAT ME ODOMETER READING IS NOT TIE ACTUAL MIRAGE.WARNING—ODOMETER DISCREPANCY W BOX(1)OR(2)IS CHECKED. . P. DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE THIS MEM ID HAS El HAS NOT(DECK oNE)susrANEo DAMAGE IN EXCESS OF 70%ACTUAL CASH VALLA. $. POLLUTION SYSTEM DISCLOSURE STATEMENT. TO TIE BEST OF MY KNOWLEDGE THE POULMC01 CONTROL SYSTEM ON TIES vegaE INaumNo GE RESTRICTED GASOUNE we' - - • 0 HAS 0 pm NOT KHEac oral BEEN mom.ALTERED OR ROVERED INOPERATIVE. . ,. P. . Mars maw HAME(S) • DATE ..i. • SIM'S SWEET ADDRESS I OTY SIAN 11P X • • . . .., • - mft.-- -iwsr------1 . . PURCHASER'S EXCISE(SALES)TiDECLARATION EME°EDE DE ' REGISTRATION TAX+ $ 4 D $ & moss WWI. PLATE FEE • I.HAL PURCHASE PRICE PURCHASER(S) REGISTRATON PERIOD ARREARS TAX . . 2 LESS TRADE-N AUXWANCE °ANEW) COWDEN HIM NG 6 TO CONVERSION FEE 4 . • MUST CHANGE OP GROSS VEHICLE WRIGHT . COMPLETE a ter PUTMAN POKE WE OF ANDoLosa • mulls TRANSFER TAX ./4/ • • TME/IRANSFER FEE S.LESS TAX PAID TO ANOTIHR STATE DATE Of C errm) NET EXCISE TAX DUE$ 4 OUNCE I I EXCISE TA)( . &ILBILLELIKT0& MAKE PLATE NUN= DATE LATE TRANSFER PENALTY MODEL YEAR CHANGE . DONS I I SUB-TOTAL$ 4 . . V. CHANGE OF WOE AND/OR GASS STATE/DEPUTY FLING FEE FROM TO 3 4'Z' I DECLARE ILI NNW TOTAL DIM S Res TAX /6) ccpy ERECT To aiNtiwitAar"ANIN0 del MS OHM II MO Wit I EXEMPTION CODE 5- s--O MOM 10 ME MOUND WOE 01111AMPO UPON it AMC SOWS NOTARY SIGNATURE SUBSCRIBED AND SWORN TO WORE ME DATE AN,IIGHWMII.if 10102 WU ME 01111/1111114 COWIMPICI M1111 111E IMO Old NOY 10 OS 0.01 Of 1001111411014 MNAE IRONED / if q i EMMR MY OF AMMOMMON NO MatinT4 WI•A cOMCLIA,1101111... MI VIIA4cAa 137.arz,....--.Of MAR AM MGM *110611L1:: • COUNTY DAN MY COMMISSION DOMES ina.olown ROC sem=ocw.martaus tzetwa&48. X ..../,.... 6(257- 7/- • OP,NOM A 10/001.10FRONDOW AIONOLS.COMEOO11001 1101111010141111!4P./MIMS 1/1 10 IRA *ONATIATEPI-... NITT 1***1599414411.'..-***ETON. DM • nPS MNNESOTA DEPARTMENT OF PUBLIC SAFETY - DIME AND VEMILE SON103 I3Ø TINISPORTATIN(RIX 395 JOHN!MLA)ER,St PAUL,MN 55155 . '$ --DO NOT SIGN UNTIL COMPLETED PS.2000-15 • , SELLER'S COPY . . . . . . . (.• (11111) ((('4 Minnesota VEHICLE '-c ) 4'''j 03124195 ((�"">)) (�..j) Vehicle 1•!"! Inspection INSPECTION P E c Bal 95 44:1:$0 ((0;.�j)) ` S CTION REPORT VER. 1 ((1: ;�)) Program 0.0.:(1.0 (( ;ij) '1;i;,) CERTIFICATE AT BOTTOM NEEDED FOR LICENSE REGISTRATION RENEWAL ni THANK YOU for cleaning up our air.Your vehicle's inspection results are printed below. If your vehicle passed the inspection, i::'l ° j) (1;1;1,1) present or mail the Inspection Certificate to the registrar when you purchase your vehicle license tabs. If your car failed, see ((i1:il) •• the back of this form for information on repair and retest requirements. Note: Repairs may be covered by the 5 year/50,000 ' (��.�� (iiiii) mile warranty provisions of the Clean Air Act. (((tilt)) (1;1;1;1) ::•:) (This emissions test complies with the EPA short test requirements.) 1((i:)) ((!!!) (b,!,!) (1111) INSPECTION FACILITY INFORMATION sill ((mu)) , •Inspection Date/Time Station ID/Fleet ID Lane No. Inspector ID/Fleet Signature Anal zer No. 4.1.:1:1:;:i)) rP 9 Y (((iii))) 06/01/93 09:5 005 01 ROGERO 0079 S2 (((ilii))) ((i;ii)) ((iiiii)) iii ((.....:) VEHICLE INFORMATION 01:1:1:(ij) (((iii))) (((ilii))) (�iiiii hill ,,,,)) License Plate Vehicle Identification Number Year Make Type Engine Yr. Mileage (�, •)) ((�!!!!�)) POLICE 1618L5373PW110:'38 1993 CHEV 4D 1993 18, 000 (!!i!) Os'esTO ((is .)) ((ilii)) ((till)) (•: •:) EXHAUST EMISSIONS READINGS / (1.11.(1) FAST IDLE (. . ) ((ilii)) LOADED (iiiii• ) (': ) INITIAL IDLE CONDITIONING FINAL IDLE �(� ��)� (11111) HC m CO % CO % HC m ?,,0 % CO % HC m CO % CO % k0.).:!)..../1) (OM)((1,11;1)) ^r r r. n n ,'• o ❑ o r. i .i r r r, O n n r, r i t (((1111))) ""') Test Maximums ..''.'1) ((hili)) $4....•1)) 0056 00. 01 14, 6 \:.•::.) Initial Test Readings ((( 4$ ((1;1;111) ,.,:.) Retest Readings .((Illi)) +tie,'., ((1111)) /(1111) Initial Test Serial No. Retest Serial No. No.of fee bearing reinsp. Waiver Serial Number Insp./Reinsp.Indicator(1=InitialTest) ' (((Iii1 `(• ')) 03141430 )� ((till!)) 1 ((iiiii)) ((iiiii)) „...,,,::s:::,., ♦ 0,0:1:1,9)0,0:1:1,9) EQUIPMENT INSPECTION RESULTS DIAGNOSTIC CODE INSPECTION ((iiia)) iiiii Fuel Inlet Catalytic Unvented RESULT C�.. ) Restrictor Converter Fuel Cap 11111 ilii �:::. ((7...)) BASS ((.;iii)) ((iiiii)) PASS PASS PASS ( ) (iiiii) (((ilii))) • (((iii)) ((iiiii)) COMMENTS: _ 7.4a6,77-7777'7:7177777-- ,.,— - �++.. ,�' .••a r ►c"+'?ti� ( ))� , a , ., i ' :^ r- 1111 ((iiiii>) lr+ C CE TI IC 03124195 0 � 5 ((111.1)) (((1111), ,ate*14°. b fVo ((1111.)) (�nlli ISS°E DATE: 06 ,—1/4/3 TEST/WAIVER SERIAL NO.: 0314419 5 VEHICLE LICENSE NO.: DL I CE . ::::)) ((11111)) (((i;j) 1e1BL 73PWi 1.0238 GHEV 199 ((U.1..0 /Illli) VIN; VEHICLE MAKE VEHICLE YEAR' hill (((1111))) , ” ' (((Il:;;.0 ((11111)) If your vehicle passel , or you obtained a waiver, an extension Or ate INSPECTION RESULT NO.CP FEE (f{1,i�i;i)) mui exemption,present or mail this Inspection Certificate to the registrar BEARING (((11�11))� Pass . RI IrECTIONS (((1111)), when you purchase your vehicle license tabs. If your vehicle #ailed, 0 ((�Ilil)) ((�lui)) see the back of this form for information on repair and retest (((111.))} requirements. (((Illlj)) ((i% i) .. �^ A�, M^ � �c----� r� nr.^^ �, ((IIIII)) 4