HomeMy WebLinkAbout1989 Chev. Blazer AnismmimminomMI
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((i,,;)� I . i,nsPecontiINSPECTION O N REPORTCertificate ID No 01.,(1.0
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00 rogram INSP 02450771 (c����>)
((i;i;.ij) VER.81 (((iiij�
(�iYij) CERTIFICATE AT BOTTOM NEEDED FOR LICENSE REGISTRATION RENEWAL (h�.).�.�>)
Ilii) THANK YOU for cleaning up our air.Your vehicle's inspection results are printed below. If your vehicle passed the inspection, (c(;: ;)��
(skim present or mail the Inspection Certificate to the registrar when you purchase your vehicle license tabs. If your car failed, see ((�' �'!))
( •• the back of this form for information on repair and retest requirements. Note: Repairs may be covered by the 5 year/50,000 (��"
.....) mile warranty provisions of the Clean Air Act.
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T::.:.:::7, (This(This emissions test complies with the EPA short test requirements.)
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INSPECTION FACILITY INFORMATION ((���))
(11111 ((1111))
...•.•.•.)) } Inspection Date/Time Station ID/Fleet ID ('?:`•;'•:�
(9,1 Lane No. Inspector ID/Fleet Signature Analyzer No. (( 1;i!))
:.:;;)� 11/20/92
((iioyij) 10: i 005 01 ROGERO 007952 (((. j)�
(((ilii))) ((i;jij)
04
VEHICLE INFORMATION
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«�) License Plate Vehicle Identification Number Year Make ("))
((11;i;1))) Type Engine Yr. Mileage ((iiil;i))
945FNT 1GNEV18K6KF131234 1989 CHEV UT 1989 000 (n014((.'iORO
ii))r(( .i;i;i;j)
(i;��:•:. EXHAUST EMISSIONS READINGS (((i'iij)
FAST IDLE `• •�
(( ii))) LOADED ((i'ii;i))
(i;:�;ij) INITIAL IDLE CONDITIONING (G:!!:!)
HC(ppm) Co(%) Co (%) HC FINAL IDLE (,,.,,.)�
(...1))> ii (ppm) CO(%) CO2(%) HC(ppm) CO(%) CO(%) (1,1;11)
2 (....)
Test Maximums r4 r4 r' ■ r,0 .� ^' r r r ni Minimum
(1111'i)) . r, r 0
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(1,1,11))
Initial Test Readings 0061 00. 09 15. 1
11110) Retest Readings (.�..4
0'40:0:0rrrJ� ::•:
(1;1;1;1))) Initial Test Serial No. Retest Serial No. No.of fee bearing reinsp. Waiver Serial Number Insp./Reinsp.Indicator(1=Initial Test) im
.i j) 00919315 02450771 0 ((�'�)�)
0 1 (( .))
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EQUIPMENT INSPECTION RESULTS •
(""�
ifis$ DIAGNOSTIC CODE INSPECTION ((sy.0
i ij) Fuel Inlet Catalytic Unvented RESULT ((�!!!!�)�
Restrictor Converter Fuel Cap (rir�1)
;.iii)) PASS PASS 0404PASS PASS ((..1;r))
..1:0) COMMENTS: 04
tkri'LILAIION 10 IIILE/REG.AVEHICLE FLAIENUMBER02YEAR FOR VALIDATION AND OFFICE USE ONLY
FOR CENTRAL OFFICE USE ONLY . - -
STICKER NUMB 01 /:--:J
YEAR /�
l
L53 / 3 ,./4M
TITL 1(..,:11'.1
ITREG. REG. TER PREVIOUS PLATE NUMBER YEAR MONTH YEAR -•,e ^
A ONLY ONLY CHANGE ���fy�J EXPIRATION 1%.
ATE OF PURCHASE 36 Y DATE61 F 199
PURCHASER(S) CHECK NATURAL GA5 );` �. /"�
OWNERS) �X'^_^- NEW USED y FUEL ��LINE�L ORT PROPANE 7/'/����,a �,Cj1T-
MUST 1 X 6 6 I ( r rypE I DIESEL OTHER ATO �A '
COMPLETE MODEL YEAR 04 MAKE :/ BODY/MODEL TYPE 06 07 FAo& -- `s
4 Vehicle ' ► r j �J NON-NEGOTIABLE REOISTTIi�L I�fa RECEIPT(CARD)AND CAB CARD
infonnatlon ! //� THIS COPY WHEN VALIDATED(STAMPED ON THE UPPER IGHT CORNER)
V ICE IDENTIFICATION NUMBER 06
( I BY A DEPUTY REGISTRAR OR THE CENTRAL OFFICE,WILL SERVE AS
�/�/,T(/�V)C(/,,,' V [a,'�J ty' 19 EVIDENCE OF TAON THIS RECEIPT HAVE BEEN X PAID FOR THE PERIOD INDICATED.THE REGISTRATION
T,AND MIDDLE NAME 10 �� { CODE: BODY � ROOF PLATES
USE ONLY NON THE VEHICLE DESCRIBED.ASSIGNED TO THE OWNER
r,PURCHASER(S) ►LAST fIR}S DRIVERS LICENSE NO.
OWNER(S) DATE OF BIRTH 14
Information ���//)) k. �t/J�!p ' /
+ OI I
�ARCIIASER(S)OWNER( LAST,FIRST,AND MI NAME(S)11&12 ` �� (
11DRIVERS LICENSE NO. DATE OF BIRTHS)64
STREET ADDRESS 13 CITY�15 COUNTY 16 STATE ZIP CODE 17
NAME�F{ (tINSU�RA8 CO. E �X
J/ ) ^POLICY NU//R 1"/C 1,1,45',/// � ,S757���
HOME TELEPHONE NO.
I.
Q /A cJ
B ► IS HIS M-IICLE UBJECT TO SECURITY AGREEMENT(S)? YES I NO IF YES,COMPLETE SECTION BELOW.
RRST SECURED PARTY(PRINT E)21 DATE OF LOAN 23
PURCHASER(S) NOTE:WHEN THERE IS A LIEN THE TITLE
OWNER(S) STREET ADDRESS 24 MUST GO TO THE FIRST SECURED PARTY.
MUSTCITY 25 STATE 26 ZIP CODE 27
COMPLETE
SECOND SECURED PARTY(PRINT NAME)28 DATE OF LOAN 30
LOAN
Informan FOR ADDITIONAL SECURED PARTIES,
ATTACH COMPLETED FORM NO.PS2017. .
STREET ADDRESS 31 CITY 32 STATE 33 ZIP CODE 34
MILES(NO TENTHS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER(SEE WARNING ON BACK OF LAST PAGE
► I (NE) THE OWNER(S) OF THE VEHICLE DESCRIBED ABOVE, CERTIFY HE ODOMETER ON THE VEHICLE NOW READS T MILES AS
SHOWN ON THE LEFT AND THAT TO THE BEST OF MYYY((OUR) KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE
SELLER(S)MUST ABOVE.
DESC
E IS.FREEIBED EOFNALLSONE OF THE FOLLOWING SSECURITY INTERESTS, WARRANT TITLE, ASSIGN THTS IS ED.E VIE IH CL)ETHE
AND TAXES PAID TO THEOF THIS VEHICLE
PERSON(S) NAMED
COMPLETE 0 (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.W DISCREPANCY IF BOX(1)OR M CHECIGED.
► DAMAGE DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE THIS VEHICLE 0 HAS 0 HAS NOT(CHECK ONE)SUSTAINED DAMAGE IN 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 GASOUNE PIPE
0 HAS 0 HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE.
110.
SELLER'S PRINTED NAME(S) DATE
SELLER'S STREET ADDRESS CITY STATE ZIP
X
SELLERS SIGNATURE(S)
D PURCHASER'S EXCISE(SALES)TAX DECLARATION BASE VALUE OR REGISTRATION TAX+ $ Q COU ('
$/3 '?' „.2GROSS WGHT.20 REFLECTORIZING FEE 16 d o 7'
1.FULL PURCHASE PRICE
PURCHASER(S) REGISTRATION PERIOD -
OWNER(S) 2.LESS TRADE-IN ALLOWANCE ARREARS TAX & PENALTY
MUST COMPLETE ITEM NO.6 ... I-ROM i.J (] / TO / 7/5/ CONVERSION FEE
COMPLETE ,//� #1.....) CHANGE OF GR SS VEHICLE WEIGHT
AND 3.NET PURCHASE PRICE /� C/if' TIME OF
SIGN �/ CHANGE
4. Rn OF LINE 3j !j-j( . • HOURS TRANSFER TAX o V
5.LESS TAX PAID TO ANOTHER STATE DATE OF TITLE/TRANSFER FEE tg. 00
NET EXCISE TAX DUE $ u CHANGE `
`Ci�� b I I EXCISE TAX 3 _I
6.7RADE-IN WAS A: MAKE PLATE NUMBS LATE TRANSFER PENALTY �c'v�
DATE
MODEL YEAR -. CHANGE
' EXPIRES SU&TOTAL$
CHANGE OF WGT.ANDIOR CLASSI STATE/DEPUTY FILING FEE 3 5 55e ot0
(DECLARE I.D.NUMBER FROM TO
THIS TAX TOTAL DUE$ S.to D 6I
EXEMPTION CODE TOIENS SFYI(WEUA0 NO DOFLEGALAGE,HAVEICLE IS HTTHISCONT ESUTO SE
LIENS S OWM AND ND OTFERS,THIS VEHCIE IS AND W91 CON IM1E ro BE
INSURED WHILE OPERATING UPON THE PUBLIC STREETS AND HIGHWAYS,THE
NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME. DATE
VEHICLE WALL BE OPERATED N COMPLIANCE WTH THE LAWS WHICH APPLY TO ITS
CLASS OF REGISTRATING,HAVE RECEIVED A CCPV OF THIS PFPUCATON AND ALL
OF MY(OUR)DECLARATIONS ARE TRUE AND CORRECT.I(WE)FURTHER CERTIFY
THAT IF THIS ISA COMMERCIAL VEHICLE I(WE)HAVE KNOWLEDGE OF STATE AND
COUNTY DATE MY COMMISSION EXPIRES FEDERAL REGUUTONS APPLICABLE TO COMMERCIAL VEHICLE OFERATpN.MN- 1 /*.'
t
NESOTA STATUTES,GRAPIER 721,PUBLIC SERVICE COMMISSON RULES 1 V
THROUGH AA,AND CODE OF FEDERAL REGULATIONS,TITLE 49,PANTS 390 A r�
THROUGH 399.AND IF A TRANSPORTER OF HAZARDOUS MATERIALS,CODE OF
FEDERAL REGULATIONS TITLE 49,PARTS 171 TO 199. SIG ATUR ';' LL PURR ,---OWNER(S)MUST • DATE
ITCDPS MINNESOTA DEPARTMENT OF PUBLIC SAFETY DO NOT SIGN TIL COM
DIVISION OF DRIVER AND VEHICLE SERVICES _ 17TRANSPORTATION BLDG.,ST PAUL,MN 55155 P.S.2000-13 -
PURCHASER'S(OWNER'S COPY)
APPLICATIONTOTITLE/REG.A VEHICLE PLATE NUMBER 02
_ YEAR ' 'FOI4 VALIDATION AND OFFICE USE ONLY
FOR CENTRAL OFFICE USE ONLY i �" i----' f ' 1 .. '
STICKER NUMBA 01 J YEAR
1-a
/
$vr f
wA'
(� 1 ` ;-
TITL TITLE REG. REG. TFR PREVIOUS PLATE NUMBER YEAR MONTH YEAR T
AONLY ONLY CHANGE 1 EXPIRATION
i- .,�' 1 61 9h t 7
PURCHASER(S) ATE OF PURCHASE 36 NATURAL GASP !2 I/"
OWNER(S) K (' NEW CHECK IGASOUNE , C-0'"e�i .L �
MUST. (J (., ' , 03 USED FUEL DIESEL OR PROPANE + fi
TYPE OTHER I1pl&°•_.1
COMPLETE MODEL YEAR 04 MAKE 05 r
��t f BODY/MODEL TYPE 08
* vehicle ► .} st,�-t (T R v i ) _,
Information .-'j / i ,
VHI LE IDENTIFICATION NUMBER 06
#jJ( jj `y+'" }, f" } _
CODE:
COLOBODY if ROOF
PURCHASER(S) iti L NAIP S �'°' .:`� �' f `_ ^7 •-:.-- *.i 19 F
OWNER(S) I.LAST,FIRST,AND MIDD E E 10 DRIVERS LICENSE NO.
DATE OF BIRTH 14
ill I I 14
information :` R _1 t .�,-;,`""
ADDITO AL PURCHASER(S)OWNER((LAST,FIRST AND MIDDLE NAME(S)11+5 12 / DRIVERS LICENSE NO. DATE OF BIRTH(S)64
11
4 STREET ADDRESS 13 I
CITY 15 COUNTY 16 STATE ZIP CODE 17
NAME OF INSURANCE CO. POLICY NUMBER HOME TELEPHONE NO.
► {' _ _
B ► IS THIS VEHICLE,SUBJECT TO SECURITY AGREEMENT(S)? YES I NO '/IF YES,COMPLETE SECTION BELOW.
FIRST SECURED PARTY(PRINT NAME)21 DATE OF LOAN 23
PURCHASER(S) NOTE:WHEN THERE ISA LIEN THE TITLE
OWNER(S) STREET ADDRESS 24 MUST GO TO THE FIRST SECURED PARTY.
MUST CITY 25 STATE 26 ZIP CODE 27
COMPLETE
SECOND SECURED PARTY(PRINT NAME)28 DATE OF LOAN 30
LOAN
Informan FOR ADDITIONAL SECURED PARTIES,
ATTACH COMPLETED FORM NO.PS2017.
STREET ADDRESS 31 CRY 32 STATE 33 ZIP CODE 34
131 MILES(NO TENTHS) ODOMETER STATEMENT AND ASSIGNMENT BY SELLER/SEE WARNING ON BACK OF LAST PAGE
► I (WE) THE OWNERS) OF THE VEHICLE DESCRIBED ABOVE, CERTIFY HE ODOMETER ON THE VEHICLE NOW READS MILES AS
SDESCRIBED HOWN ON THE LEFT AND THAT TO THE BEST OF MY T((OUR) KNOWLEDGE THAT R REFLECTS THE HE (A(CTUAL MILEAGE OF THE VEHICLE
SELLER(S) VEHICLEABOVIS REEEOFNALL SSECURITY INTERESTS, WARONE OF THE FOLLOWING RANT TITLE,SASSGN THE VECHECKED. I HICELETAND TAXES SPAOF THIS ID TO THE HPERSONS)INAMED
MUSTCOMPLETE 0 (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 IS CHECKED.
► DAMAGE DISCLOSURE STATEMENT.TO THE BEST OF MY KNOWLEDGE THIS VEHICLE 0 HAS 0 HAS NOT(CHECK ONE)SUSTAINED DAMAGE IN 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
0 HAS 0 HAS NOT(CHECK ONE)BEEN REMOVED,ALTERED OR RENDERED INOPERATIVE.
SELLER'S PRINTED NAME(S)
DATE
SELLER'S STREET ADDRESS CRY STATE ZIP
X
SELLER'S SIGNATURE(S)
PURCHASER'S EXCISE(SALES)TAX DECLARATION BASE VALUE OR REGISTRATION TAX + $ / e K , 4
D Si, f Q GROSS WGHT.20 .....•••••11/ON
1.FULL PURCHASE PRICE .✓ f J� REFLECTORIZING FEE,erf,' �!-:'> T
PURCHASER(S) REGISTRATION PERIOD
OWNER(S) 2.LESS TRADE-IN ALLOWANCE j ."2./
(( ARREARS TAX & PENALTY
MUST COMPLETE REM N0.6 -- ^^"�" "' FROM ( O(S J TO 1 •j J
•
COMPLETE • / f , CONVERSION FEE
,',/ J CHANGE OF GR S VEHICLE WEIGHT
AND 3.NET PURCHASE PRICE / J
f HOURS ��
SIGN 4. %OF LINE 3 y/x, CHANGE TRANSFER TAX t J
5.LESS TAX PAID TO ANOTHER STATE "r T DATE OF TITLE/TRANSFER FEE ,. ( �(;`,
NET EXCISE TAX DUE $ ; ) CHANGE I I EXCISE TAX
6.TRADE-IN WAS A: MAKE PLATE NUMBERDATE LATE TRANSFER.PENALTY . `I /. ?
MODEL YEAR CHANGE
EXPIRES SUB-TOTAL$ '::1.5.4..--' e
CHANGE OF WGT.AND/OR CLASS I
I.D.NUMBER
I DECLARE
FROM TO STATE/DEPUTY FILING FEE - ,(.�
THIS TAX TOTAL DUE$ - 0
EXEMPTION CODE O UONRTIF1'N A"1NO OT P�DUAGE.HAVEe0u0 D POLL /SOT1M E TO 9 cr:.,
1b DENS SHOWN AND NO OTHERS,THIS VEHICLE S AND WILL CONTINUE TO BE t.''
E INSURED WHILE OPERATING UPON THE PUBLIC SII¢tIS AND HIGHWAYS,THE
NOTARY SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME. DAT
VEHICLE WILL BE OPERATED IN COMPLIANCE WTIH THE LAWS WHICH APPLY TO ITS X
CLASS OF REGISTRATNG,HAVE RECENED A COPY OF THIS APPLICATION AND ALL
OF MY(OUR)DECLARATIONS ARE TRUE AND CORRECT.I(WE)FURTIER CERTIFY
THAT IF THIS IS A COMMERCIAL VEHICLE I(WE)HAVE IPIOWM1EOGE OF STATE AND
COUNTY DATE MY COMMISSION EXPIRES FEDERALRE.IAATOWS APPLICABLE TO°°MMERCIAL VEHICLE OPERATION,MIN- 't
NESOTA STATUTES,CHAPTER 221,PUBLIC SERVICE COMMISSION RULES 1
THROUGH 48,AND CODE CF FEDERAL REGULATIONS,TIRE 49,PARTS 980 X /9
THROUGH 399,AND F A TRANSPORTER CF HAZARDOUS MATERIALS,CODE OF C/
FEDERAL REGULATIONS TITLE 49,PARTS 17110/99. SIGNATOR LL PURCH OWNER(S)MUST DATE
SPS MINNESODIVISIONTA DEPARTMENT OF PUBLIC SAFETY DO NOT SIGN IL COM MEDOF DRIVER AND VEHICLE SERVICES N'
TRANSPORTATION BLDG.,ST PAUL,MN 55155 P.S.2000-13
MEMO.OPPORTUNITY SELLER'S COPY
APPLICATION TO TITLE/REG.A VEHICLE PLATE NUMBER 02 YEAR FOR VALIDATION AND OFFICE USE ONLY
FOR CENTRAL OFFICE USE ONLY .
STICKER NUMBER 01 j YEAR _ ,k,.r"
1 LA 1r
TITLE TITLE REG. REG. TFR PREVIOUS PLATE NUMBER YEAR MONTH YEAR
A REG. ONLY ONLY CHANGE EXPIRATION -
DATE
61
PURCHASER(S) DATE OF PURCHASE 36 CHECK NATURAL GAS
OWNER(S) _ NEW GASOLINE_ OR PROPANE - 419 kk USED ,if FUELv 7/6
MUST # f 03 TYPE I DIESEL OTHER
COMPLETE MODEL YEAR 04 MAKE 05 BODYIMODEL TYPE 08
* vehicle ► j • / ;
information >
HICLE IDENTIFICATION NUMBER 06 "
COLOR
.' 1 i; } / CODE BODY ROOF,
!!! • 19
PURCHASER(S) 1,,.LAST,FIRST,AND MIDDLE NA E 10 DRIVERS LICENSE NO. DATE OF BIRTH 14
OWNER(S)
information '
rmf:
4 ADDITIONAL PURCitiASER(S)OWNER(S)LAST,FIRST,AND MIDDLE NAME(S)11&12 DRIVERS LICENSE NO DATE OF BIRTH(S)64
STREET ADDRESS 13 CITY 15
COUNTY - 16 STATE ZIP CODE 17
3 ,‘.. ' (... a'} - ....L.-
NAME OF INSURANCE CO. POLICY NUMBER HOME TELF,,S'HONE NO.
tir j
B ► IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? YES NO IF YES,COMPLETE SECTION BELOW.
FIRST SECURED PARTY(PRINT NAME)21 DATE OF LOAN 23
NOTE:WHEN THERE ISA LIEN THE TITLE
PURCHASER(S)
OWNER(S) MUST GO TO THE FIRST SECURED PARTY.
MUST STREET ADDRESS 24 CITY 25 STATE 26 ZIP CODE 27
COMPLETE
SECOND SECURED PARTY(PRINT NAME)28 DATE OF LOAN 30
LOANFOR ADDITIONAL SECURED PARTIES,
information ATTACH COMPLETED FORM NO.PS2017.
STREET ADDRESS 31 CITY 32 STATE 33 - ZIP CODE 34
All data collected on a motor vehicle application, with the exception of your home
telephone number, are required by law. These data are used to identify your motor vehicle.
Failure to provide required data may result in denial of the transfer of ownership,
registration of this vehicle, or other requested action. Except for excise (sales) tax data,
your motor vehicle record is public and transcripts may be issued to anyone.
P.S.2000-13
LENDER'S COPY
026756
1/8/91 Title , Registration & Tax 1989 Blazer, 1991 Ford LTD, 1989 Chevrolet
873 . 14 101-41510-417
7 )
,-,
/
CERTIFICATE OF ORIGIN FOR A VEHICLE ::;:•,,.. 7 -
..,, ,....._ ,44.,..N..
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Y00424
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DATE
INVOICE NO.
12/11/88 - , ' •• ,- 10010835378
VEHICLE IDENTIFICATION NO. YEAR
MAKE
,.. I.GNEV18K 6KF1.31234 1989 CHEVROLET
„.
---*
BODY TYPE
SHIPPING WEIGHT
,i BLAZER 4WD .
4620
.,... :
H.P.(S A.E.) - G.V.W.R. NO.CYLS. SERIES OR MODEL
•,' •
5102 6100 , 08 C V10516
—,......_,.
--. , ,,
.................
Pio Yoke , -CAPACITY HSP.(J245)
1/2 TON ; . N/A .' 210
.;.... '
. •
I.the undersigned authorized representative of company, firm or corporation named below hereby cer-
tify that the new vehicle described above is the property of the said company, firm or corporation and is
transferred on the above date and under the Invoice Number indicated to the following distributor or dealer.
NAME OF DISTRIBUTOR DEALER,ETC
04328 593. •
1_1)2 .t. ,
.:-
. .
THANE HAWKINS POLAR CHEVROLET, INC.
1801 E COUNTY RD F • . ' '
'WHITE BEAR LAKE MN 55110-0557
.., ..,„. .
:.:It is further certified that this was the first transfer of such new vehicle in 1:ordinary trade and commerce.
,- - 1' 0 e '
h • '' _ CHEVROLET MOTOR DIVISION
..,.....;.. ' GENERAL MOTORS CORPORATION A ''
. •
- .
---.7" - BY:
.............. ' - (SIGNATURE OF AUTHORIZED REPRESENTATIVE) (AGENT)
. xe.
G15936815 . . . ,
,- 30007 VAN DYKE, WARREN MI 48090
CITY-STATE ,.,
- .
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AI_ Thanoe Hawkins
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Chevrolet 11! IIQr& kAtazdck
0 STATEMENT DATE - 1801 E. CO. RD. F• WHITE BEAR LAKE, MN 55110
TELEPHONE 429-7791
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CITY A OAK f-AYik, il.E.N.A.TS
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STILLATE'; mN 55%2
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Ai TN: ACCOLNTS
C.Wrt..01,.. it 2t,-;1.,.:6 AMOUNT ENCLOSED____ ____________
TRANSACTIONS AFTER 25TH OF MONTH WILL APPEAR ON NEXT STATEMENT.
TERMS:NET CASH BEFORE 10TH OF MONTH.
•
PLEASE RETURN THIS STUB WITH YOUR CHECK
'-Your .INANCE CHARGE is computed by a single periodic rate of 1.33% per month which is an
0
ANNUAL PERCENTAGE RATE of 16%.
_
.
•
NOTICE: See reverse side for important information.regarding identification of the charges appearing on this statement
0
DATE SOURCE
Important Information regarding your right to dispute billing errors.
SOURCE 111211322m1.11111111132manillin
PAYMENTS AND CREDITS
BALANCE
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111 - ,, %-, .' , , , .,,,. = ', ,,' • , ,,, , , , < §' ,
FINANCE CHARGE
S
.ANALYSIS OF ACCOUNT
CU '''''''''''''''''S''''''''''''''OVER 30 '''''''''''''''''A OVER W DAYS ;
OVER 90 DAYS • OVER 120 DAYS PAY THIS AMOUNT
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*Polo
ii, SEND
THANE HAWKINS
TO AVOID ADDITIONAL Fl .NCE C'ARGES PAY TN_ NEW BALANCE NEW BALANCE
gpr INQUIRIES TO:
POLAR CHEVROLET&MAZDA NOTE: TR,TarTiag,TAY,TeLvcravaLarTBsATLAATNECMEESNOrVM
WHITE BEAR LAKE, MN,55110
DAYS PAST OUE
ADVERTISING/
Thane Hawkins Cv�I (;.y�,r ,f,rpy r. (TYPE)
HO E. CtY Rd. F SALESPERSON (NAME)
.HIHH10'-'
'�� WHITE BEAR LAKE, MN. 55110 �S'v i�
Ma
DATE
1\�) 429-7791 .)z„,'.L.:
STOCK#
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INS.CO.
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POLICY#
BUYER'S ; .":'Y 'It' 'iet LL, .h i*,1'..7 1.11,',.�
NAME- NAME CO-BUYER
NAME
BUYER'S CO-BUYER'S
DRIVERS LIC. # DOB DRIVERS LIC. # DOB
STREET .14.1.1.;1, j`i"'l S"Ltr:f_.T .'\"Ir-Ch RESIDENCE 4 )-s-44 }L
ADDRESS PHONE
CITY, STATE ST1i..L4, FTE:'Z , ¢;!U (!1#t' i.i N(.3T ) iu.� , `ti 3i)cr_.' BUSINESS
COUNTY,ZIP PHONE
���� i.,L L, r";, '\JLe')i ``r` r7-..,1 I°LL, !-I
� ,ht,F'lt 4X4
PLEASE ENTER MY ORDER FOR A_USED R
DEMO (YEAR AND MAKE) TRUCK .i (MODEL) (BODY TYPE)
COLOR BODY )-11"11-.2 ROOF hLLrr 1_(_,N}..,,-‘,1, r1_11.134
TRIM SERIAL NO.
CASH DELIVERED PRICE OF UNIT $ LOCALLY INSTALLED OPTIONS $
FREIGHT v!21. .
OPTIONS 5S > `:c v,I.:N1 `:iv, t (;'tc:4
f
TOTAL PRICE OF UNIT $ 164Y-,.00
TRADE IN YR. MAKE
MODEL AND EQUIP
TRADE IN ALLOW.AND DISC. $ r\4/L,
BALANCE $ 1t 4y ).O )
LOCAL DEALER HANDLING AND ADJUSTMENTS $ INCLUDED
RUSTPROOFING YES NO k $
PAINT SEALANT YES NO X $ X.
FABRIC PROTECTOR YES NO $
BALANCE $ 1L;499.00i
SALES TAX $ : - N/.y
LICENSE $ N/A.
DOCUMENT ADMINISTRATION FEE $___ ____-"32701,--
'
RECORDING/TRANSFER + CERTIFICATION — $
BALANCE FEES
$ I14t-(d.OD
LESS CASH DEPOSIT $ N/.1
Buyer certifies that all pollution control equipment CUSTOMERS SIGNATURE SERVICE CONTRACT YES NO X $
on,the trade-in vehicle is intact and in operating
condition. X BALANCE DUE ON DELIVERY $ 1E)4 .!)0
DEALER DISCLAIMER OF WARRANTIES - - - - - -
Any warranties on the products sold hereby are those of the manufacturer. As between the retail seller, Thane Hawkins 11 t.. .1% Zj 9
Polar Chevrolet,Inc.,and buyer,the product is to he sold as is,and the entire risk as to the quality arid performance of the DATE
product is with the buyer.The seller expressly disclaims all warranties,either express or implied including any implied co 1 /J��
warranty of merchantability or�fifnes far a particular purpose,and the seller leather assn nes nor author,es any other_ �7' �
person to assume for it any yablllty in connection with the sale of said prod its. The buye. acknowledges be ng so // [ �J�//�
informed prior to the sale. / _ MER SIGNA I URE
The front and back.o,{his CO TRACT comprise the entire RAP Taffecting this purchase.The DEALER will not recognize any verba)agreement,or
of any nature.I certify at no edit has,tieen extended tom f the purchase of this motor VEHICLE except as appearsany other agreement or-und landing
The terms of this CONTRAC were agreed upon and the EON ACT signed in this dealership on the date in writing on the face of this CONTRACT.
noted at top of this/forn5.If OU arefarrang ng credit far ME this CONTRACT is not valid until a credit
disclosure is madeasitdesc ed in R¢gulatiof:Z arr,fI ha% accepted the credit extended. IMPORTANT.( UNDERSTAND-THAT THIS MAY BE-A BINDING
t'�
NOTICE OF SAkEAIyIAN� �lfiKlTfD AUTWOR y CONTRACT AND I MAY LOSE ANY DEPOS .61E I DO T PER-
FA:-'M ACcOR GC 3'ITS TERMS
�(� ff
, DAN
'
Accepted ,.ff L .' /r� � +f r,s`.'�� ompany. //This order is not valid unless signed and accepted by Sales Manager or Officer of Cuyers Signature /
THIS ODOMETER MILEAGE STATEMENT REFERS TO VEHICLE BEING SOLD
You are required by law to disclose the actual odometerreading at the time of transfer.Any false statement may make you liable for civil and criminal penalties pursuant to the Federal Motor
Vehicle Information and Cost Savings Act and Minnesota Laws 1973 Chapter 264 and 1977 Chapter 105.
I(we)_ THANE HAWKINS.POLAR CHEV.&MAZDA,INC. ,the ownerls)of this vehicle,certify the vehicle is free of security interests.Warrant title,assign the vehicle and taxes paid
,r...a.or.IUM.(n.m.-w..
to the personlsl,roe below and state that the odometer on the vehicle described below now reads '..
,r/iile ometers.
CHECK 11)I hereby certify that to the best of my knowledge the odometer reading as stated above reflects the actual mileage of the vehicle described below.
ONE ❑ 12)I hereby certify that to the best of my knowledge the odometer reading as stated above reflects the amount of mileage in excess of designed mechanical odometer limit of
BOX 99,999 miles/kilometers of the vehicle described below.
ONLY E '13)1 hereby certify that to the best of my knowledge the odometer reading as stated above is not the actual mileage of vehicle described below and should not be relied upon:
MODEL YR. M (CE BOLD MO L TYPE SERIAL NUMBER(VIN(
�1-,,,P t LICENSE NO. LIC.EXP.DATE
ii :s\r-'\, .�, � r
r. ��. � r 54
CHECK 1111 hereby certify that the odometer of said vehicle was not altered,set back or disconnected while on my possession and I have no knowledge of anyone el ing so.
ONE El (2)I hereby certify that the odometer was altered for repair or replacement purposes while in my possession'and)that the mileage registered on the repair d or replacement.
BOXodometer was identical to that before such service.
El131 I hereby certify that the repaired or replacement odometer was incapable of registering the same mileage/that it west reset to rand tMgt them.ea a on the original
odometer or odometer before repair was miles/kilometers; ., ��o// //i g g
TRANSFEROR'S(SELLER)STREET ADDRESS CITY I STATE ZIP T rE,Ro.R,"Ss ) il(T ` Ei,,,,,,/ ,,,,,,,../71.,‘ PATE '
1801 E.CTY R0.F 1t'. E, C'. 17, Ti�fi�i_:> WHITE BEAR LAKES y/n MN '^ 55110 tV. �xq� CITY / / /, �, STATE P
TR }SE REE'S N ME IBIY R) STREET t / 4
' Ary if' , / - t ST EET ADDRES
Receipt of copy acknowledged.Transferee's(Buyer)Signature( r ��'
��-�'Vis' C%��'_: a>G�'-'i^ 14:0„).;:„....,".n.
AUTO SERVICE CENTER •
BRAKES • SHOCKS • BALANCING • TUNEUPS • ALIGNMENTS
EXHAUST • BATTERIES • RADIATOR FLUSH
i -A Al ...7-= V
'7
/ 7
/ , / C (--t
_ dY
� / (Sedie".
� � � � �
FRED'S TIRE CO.
STILLWATER
WHITE BEAR ST.PAUL
439-0403 0=11 Mal
14520 N.601M1 St
3955 Hwy.81 N. 519 Unly.Ave.
POLLUTION CONTROL SYSTEM DISCLOSURE
Transferor's (Seller's)
Name , r,• ,
Transferee's (Buyer's) Name 7 Va�, � �h,
``�i . .l'V'-\ .�,r, VIN
Vehicle Description Year Make Model
person may transfer a motor
Iorderi comply vidh. Minnesota disclosure toion 325E.0951, no the transferee (buyr) certifying the condition of
vehicle without providing a written d
the pollution control system. that the pollution control system
Transferor(seller)hereby certifies,to the best of his/her knowledge,
on this vehicle, including
the restricted gasoline pipe, has not been removed, altered, or rendered
inoperative.
Receipt of copy
acknowledged
1 , , ; / , Bu er's Signa rs
eller'sSignature Traf'sferees( Y )
Tr-nsferor's (Seller's)
#PCSD 8-88
Reorder from MADA Services, Inc., 277 University Ave., St. Paul, MN 55103