Vehicle Title_Misc_01/06/2010A05193
Mail Lien Satisfaction to: Dept of Highway Safety and Motor Vehicles, Neil Kirkman Building, Tallahassee, FL 32399-0500
Identification Number Year Make BodyE WI-L-BHP Vessel Regis. No. T103623
Title Number
1FVACWDK2ADAP7206�2010�FREII AM 8919� 127�
Registered Owner: Date of Issue 01/06/2010
Lien Release
VILLAGE OF TEQUESTA FL Interest in the described vehicle is hereby released
357 TEQUESTA DR By
TEQUESTA FL 33469-3062 Title
Date
IMPORTANT INFORMATION
1. When ownership of the vehicle described herein is
transferred, the seller MUST complete in full the
Transfer of Title by Seller section at the bottom of
_ Mail TO: the certificate of title.
2. Upon sale of this vehicle, the seller must complete
_ VILLAGE OF TEQUESTA FL the notice of sale on the reverse side of this form.
TEQUESTA
ESTA DR 357
3. Remove your license plate from the vehicle.
- _ Q
TEQUESTA FL 33469-3062
4. See the web address below for more information and
the appropriate forms required for the purchaser to
title and register the vehicle, mobile home or vessel:
http://www.hsmv.state.fl.us/htmi/titlinf.html
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1FVACWDK2ADAP7206 12 FRET AM jT
891
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EL
r� Primary Brand SecoDtlary Brand Sta
Vessel Regis. No. Title Number r ��
Lien Releases
TiO3623127 Interest in the described vehicle is hereby released
gong Use Prev Issue Date By
F Odometer Status or Vessel Manufacturer or OH use Hull Material
54 MILES 12/21/2009 ACTUAL
Registered Owner
VILLAGE OF TEQUESTA FL
357 TEQUESTA DR
TEQUESTA FL 33469-3062
1st Lierlllolder
NONE
DIVISION OF MOTOR VEHICLES
Director
IV Tole
Prop.. Date of Issue
01/06/2010 Date
TALLAHASSEE / FLORIDA
Co-°tm° au rFT 096979535
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
Julie L. Jones
Executive Director
TRANSFER OF TITLE BY SELLER (This section must be completed at the time of sale.)
Federal and/or state few require that the seller state the milege, purchaser's nunro, selling price and dale sold in connection with the transfor of ownership.
Failure to complele orproviding a false statement may resuh in fines and/or imprisonment.
This title is war anted to be free from any liens excepl as noted on the face of the calificate and the motor vehicle or vessel described is hereby uvnsferred lo:
Seller Musi Enler Purchwer's Name:
Address:
Seller Most Enter Selling Price:
Seller Must Enter Date Sold:
I1We state that this ❑ 5 or❑ 6 digit odometer now reads I �_j L_I
L_1�_�1_1.1_LL1 (no tenths) miles, date read and I hereby certify that to the best ofrny knowledge the odometer reading:
1. refl eels ACTUAL MIL..EACE.
is M EXCESS OF' ITS MECHANICAL I: DbLI'I'S. ❑ 3. is NOT THE. ACTUAL. MILEAGE.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
%E_'LLE'R Most -.
CO -SELLER Must
-
sign Here'... _. _. ...—__----
Sign Here:
-
Print Here:
Print Here:
Selling Dealer's LicenseNtenber:
". Tax No.: Tax Collected:
Auction Nuroe
License Number:
PURCHASER Musl
CO•PURCHA.SER Moat
Sign Here: _
Sign Here:
--,�
iPrinl
Here:
- Print Here:
NOTICE: PENALTY IS: REQUIRED BY LAW IF NOT SUBMITTED FOR TRANSFER wrriu ! 39 DAYS AFTER DATE OF PURCHASE
' n
=—
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
Neil Kirkman Building - Tallahassee, FL 32399-0620
Notice of Sale of Motor Vehicle, Mobile Home or Vessel
Section 319.22(2), Florida Statutes, provides that by filing this form, you can avoid any civil liability for the operation of the sold motor vehicle, vessel or mobile home.
In addition to filing this form, we suggest you keep a copy of your bill of sale (we suggest it be notarized), certificate of title or other type of transaction document showing
the vehicle was sold. Complete the information below, tear the top portion of this document at the perforation and mail to the address above or submit to your
local tax collector's office or license plate agency.
I have this day of , transferred by assignment of and delivered Florida Certificate of Title to:
Name: Purchaser(s)
Address
Selling Price $
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Seller's Signature
Co -Seller's Signature
NOTE: THE SUBMISSION OF THIS FORM, ACCURATELY COMPLETED, TO A TAX COLLECTOR'S OFFICE, LICENSE PLATE AGENCY OR TO THE
ADDRESS ABOVE WILL ALLOW THE TITLE CLERK TO UPDATE THE DMV DATABASE TO REFLECT THE TITLE RECORD AS "SOLD". HOWEVER,
THE OWNERSHIP STATUS WILL NOT CHANGE UNTIL THE PURCHASER APPLIES FOR AND IS ISSUED A CERTIFICATE OF TITLE.
1 E 7
.ODOMETEsRCERTIFICATION -
_.:selling -Dealer's Selling Dealer s -
Tax
::. ju
License No,: gr - Nae:.:::<.:Collected:
<?
a
Selling Dealer's Address:IDa[e
Sold: _
Purchaser's.Name(s):-Address
_
w
UWE STATE THAT THIS 5 OR h DIGIT ODOMETER NOW READS
XX (No rE,NTHS) MILFS, DATE
READ / /_ , AND 1 HEREBY
_
CERTIFY THAT TO THE BES
_
T OFMY KNOWLEDGE THE ODOMETER READING. -
,.
CAUTION: READ CAREFULLY ❑ 1. REFLECTS ACTUAL MILEAGE 2.
IS IN EXCESS OF ITS MECHANICAL LIMITS
❑ -1. IS NOT THE ACTUAL MILEAGE.
F
BEFORE: YOU
(EXCESS OF ITS MECHANICAL LIMITS
WARNING -ODOMETER DISCREPANCY
z
m
CHECK A BOX
.APPLIES -10 5 DIGIT ODOMETERS)
i
Z
J
Purchaser Must
Co -Purchaser Must
7,
Sign Here:
Sign Here:----._.._�_--_---------
a
w
�
Print Here:
Prim Here:
z
Seller/Agent Must
Auction 'Name (When Applicable):
Sign Here: _
Pnnt Here: Auction License Number:
Selling Dealer's Selling Dealer's Tax Tax
License No.: Name: No.: Collected:
Selling Dealer's Address: Date Sold
Purchaser's Name(s): Address:
I/WE STATE THAT THIS 5 OR ❑ 6 DIGIT ODOMETER NOW READS XX (NO TENTHS) MILES, DATE READ __' /______ , AND I HEREBY
C'. ERTIFY I HAT TO THE BEST OF MY KNOWLrI)GE THE ODOMETER READING:
CAUTION: READ CAREFULLY ❑ I. REFLECTS ACTUAL MILEAGE ❑ 2. IS IN EV F.SS OF ITS MECHANICAL LIMITS � 3. 1S NOI' THE. ACTUAL MILEAGE.
BEFORE YOGI IF-XC FSS OF' ITS MECHANICAL LIMITS WARNING - ODOMETER DISCREPANCY
CHECK.A BOX APPLIES TO 5 DIGIT ODOMETERS)
Purchaser Must Co -Purchaser Must
Sign Here: Sign Ile —
Print Here:
Seller/Agent Must
Sign Here:
Print Here:
Selling Dealer's
License No.:
Print Here:
Auction Name (When Applicable):
Auction License Number:
Selling Dealer's Tax
Name: No.:
Tax
Collected:
s, I Selling Dealer's Address: Date Sold
Purchaser's Names :
Address:
Z
I/WE STATE THAT THIS 5 OR
❑ 6 DIGIT ODOMETER NOW READS ETTI XX (NO TENTHS) MILES: DATE READ:___ _ i _ , AND f HEREBY
v
l�.J
CERTIFY THAI" TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING:
CAUTION: READ CAREFULLY
: ❑ 1. REFLECTS ACTUAL MILEAGE ❑ 2, IS IN EXCESS OF ITS MECHANICAL. LIMITS F—] 3. IS NOT THE; ACTUAL: MILEAGE.
BEFORE YOU
(FXI ).SS OF ITS MECHANICAL LIMITS WARNING - ODOMET.ER, DISCREPANCY
z
m
CHECK A BOX
APPLIES TO 5 DIGIT ODOMETERS) '
Purchaser Must
:Co-Pa:rchaser Must
�:-
Sign Here:".Sign
-----
Here
-- -- -- - - — — -
a.:
Print there _
_ _ Print Here.
SelterlAgent Must
Auction Name (When Applicable) :.
Situ Here; r
PrintHere _____
_ �'Austroa L>r-arise Nz(triber`, .
ODOMETER DISCLOSURE STATEMENT
FEDERAL LAW (AND STATE LAW, IF APPLICABLE) REQUIRES THAT YOU STATE THE MILEAGE UPON
TRANSFER OF OWNERSHIP FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RE-
SULT IN FINES AND/OR IMPRISONMENT.
I/WE WHEELED COACH INDUSTRIES, INC. STATE THAT
R (TRANSFEROS NAME- SELLER —PRINT)
THE ODOMETER NOW READS 00054 MILES AND TO THE
ODOMETER READING (NO TENTHS)
BEST OF MY/OUR KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE
DESCRIBED BELOW, UNLESS ONE OF THE FOLLOWING STATEMENTS IS CHECKED
❑ (1) I/WE, HEREBY CERTIFY THAT TO THE BEST OF MY/OUR KNOWLEDGE THE
ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS
MECHANICAL LIMITS.
❑ (2) I/WE HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL
MILEAGE. WARNING - ODOMETER DISCREPANCY
DATE OF STATEMENT
12/21/09
YEAR MAKE MODEL BODY TYPE
2010 FREIGHTLINER AMBULANCE
VEHICLE IDENTIFICATION NO. DEALER STOCK NO
1FVACWDK2ADAP7206 I 299095
TRANSFEROR'S SIGNATURE (SELLER)
ail TRANSFEROR'S NAME (PRINT NAME IN FULL)
X
NANCY A AUSTIN
TRANSFEROR'S STREET ADDRESS (SELLER)
2737 N. FORSYTH ROAD
WINTER PARK, FL 32792
MAILING ADDRESS (INCLUDES STREET NUMBER AND NAME. RURAL DELIVERY, BOX ANDlOR APARTMENT NUMBER)
P.O. BOX 677339
(CITY)
(STATE) (ZIP CODE)
ORLANDO
FLORIDA 32867-7339
TRANSFEREE'S SIGNATURE (BUYER) TRANSFEREES NAME (PRINT FULL NAME)
X
TRANSFEREE'S NAME (BUYER)
TRANSFEREE'S STREET ADDRESS'
MAILING ADDRESS (INCLUDES STREET NUMBER AND NAME, RURAL DELIVERY BOX ANDiOR APARTMENT NUMBER;
(CITY) (STATE) (ZIP CODE)
WC01SN12 Rev.12-95
WAR275 ~~`ilt` Trucks ~[OCth ~I"1~1C
Warranty Stdl'tTHIS VEHICLE IS REGISTERED TO BODY BUILDER/FAX END USER INFO
Form must be completed, signed, and returned to Daimler Trucks North America LLC.
X Vehicle was registered online. Vehicle was NOT registered online.
Mail form to: Mail form to:
Document Services Warranty Department
Daimler Trucks North America LLC Daimler Trucks North America LLC
PO Box 3849 PO Box 4090
Portland OR 97208-3849 Portland OR 97208-4090
Note: Completed and signed form may be scanned and attached to an Inquiry
Ticket via AccessFreightliner.com> My Tickets and Submit an Inquiry.
Dealer Contact Name - Phone
ERIN BRADY, TITLE CLERK 407-295-3846
Dealer Code
~BFFD Email
ebrady@orlandofreightliner.com FAX 407-291-8408
Body Builder i3ody Builder ~
(if applicable) enY WHEELED COACH INDUSTRIES Na e
Heidi Jardine
Nam
Email
heidi.jardine@wheeledcoach.com
Address
P. O. BOX 677339
City :
ORLANDO State /
Province
FL Country Zip
USA (P°stai 32867
Code)
::Vehicle
Vehicle Identi£cation Numttea (VIN) -17 characters
FTL r STL ~ WST ~- FCCC r TBB 1 FVACWDK2ADAP7206
Date in serviced Distance at in-service ~»,, MI
~
(
~"
KM
Name Phone
Customer
Email ~ _ -__ .~......_ ..__
Address
City State / Country Zip
(Postal
Province
Code)
I certify that this vehicle will be used only for the following vocation (check one only, exclude this section for FCCC).
r~ Airport ~ Inter-city Bus Service rPara-transit Van Service ~ Shuttle Bus-Light Duty
Charter/Shuttle/Transit Inter-city Bus/Coach ~ Pickup and Delivery/Short Haul ~ Suburban Bus
Church/Prison/Activity ~' Intra-city Bus Service Recreation ~ Transit/Airport Shuttle
Construction ~' Line Haul/Long Haul ~ Refuse ~ Utility/Repair Maintenance
~
Wrecking Service
~, Farm (~; Logging Service ~ Rescue and Emergency )
Fire Service Mining Road/Rail Service r
Heavy Haul Service Oil Field School Bus Service
I understand that towing may not be included in my coverage. I have reviewed the Customer Protection Plans.
I ~~ DO ~ do NOT want to purchase towing coverage for this I (-; DO ~ do NOT want to purchase extended coverage for this vehicle.
vehicle.
I understand that all information regarding this vehicle (e.g., Recall and Field Service Campaigns, etc.) will be mailed to the above (Customer)
name and address.
I acknowledge receipt of the applicable Owner's Warranty Information book and accept the terms and conditions set forth therein including th
Limited Warranty, Warranty disclaimer, and Limitation of Liability.
~I certify that I have received the applicable Maintenance Manual and Operator's Manual.
~I acknowledge that I have been instructed on correct fifth wheel operation (if applicable).
~I acknowled a that the Federal Safe Standards and Emission stickers are affixed to the driver's doorframe.
Customer signature (REQUIRED) Date
Dealer: (1) Save copy of completed form for your file. (2) Return original form to Daimler Trucks North America LLC.
Print Form
WAR275 (12/2008)
CNTY# AGY# SUB# RPT#txe
�''
TRANSACTION ID
-
RVA, Fill
`19fil ' I III
�'
6 3
RMI 2756 '& �
L# 1683064
a. e ;
� .��
STATE OF FLORIDA
T11 60867 �678
AUDIT# rooms
APPLICATION FOR VEHICLENESSEL
B# 960084
J
CERTIFICATE OF TITLE - -
TITLE NUMBER VEHICLENESSEL IDENTIFICATION #
YR. MAKE MAKE or BODY VEHICLE COLOR WT/LENGTH GVW/LOC
MANUFACTURER TYPE
103623127 1FVACWDK2ADAP7206
2010 1REI
AM LYEL
8919
—�
--
—
DATE OF ISSUE TRANS VEHICLE USE HULL
PROPULSION FUEL VESSEL WATER FL NUMBER
MO. DAY YEAR CODE MATERIAL
06 10 ORT MRiVATF,
TYPE
BIRTHDATE RESIDENT CNTY
SEX MO. DAY YEAR Y N ALIEN RES. t
Applicant/Owner's Name & Address
V ILLAGE OF TEQUESTA FL
—
F F11 � X F 6
357 TEQUESTA DR
TEQUESTA. FL 33469-3062
1st OWNER FUDL# OR 2nd OWNER FUDL# OR
F.E.I.D.# UNIT #
VOLUNTARY CONTRIBUTIONS
AGENCY TITLE FEE SALES TAX GRAND TOTAL
FEE
i 4.75 73.50 0.00 78.25
Action Requested: ORIG NEW TITLE
Brands:
PREV. STATE DATE ACQUIRED
12/21 /2009
LIEN INFORMATION
NAME OF FIRST LIENHOLDER:
ADDRESS
NEW USED (ODOMETER/VESSEL MANUFACTURER ODOMETER
DECLARATION
_
XX 54 MILES 12/21/2009 ACTUAL DECLARATION
DATE OF LIEN RECEIVED DATE FEID # OR FL / DL AND SEX AND DATE OF BIRTH DMV ACCOUNT #
SELLER INFORMATION
NAME OF SELLER, FLORIDA DEALER, OR OTHER PREVIOUS OWNER
ADDRESS
SALVAGETYPE
DEALER LICENSE NO.
CONSUMER OR SALES TAX EXEMPTION #
SALES TAX AND USE REPORT INDICATE TOTAL PURCHASE PRICE, INCLUDING ANY $
TRANSFER OF TITLE ❑ UNPAID BALANCE DUE SELLER, BANK OR OTHERS
PURCHASER HOLDS VALID
IS EXEMPT FROM EXEMPTION CERTIFICATE INDICATE SALES OR USE TAX DUE AS PROVIDED BY CHAPTER $ �)
FLORIDA SALES OR ❑ VEHICLE / VESSEL WILL BE 212, FLORIDA STATUTES
USE TAX FOR THE USED EXCLUSIVELY FOR RENTAL
REASON(S) CHECKED ® OTHER EXEMPT ❑ SELLING PRICE VERIFIED
APPLICANT CERTIFICATION
I/WE HEREBY CERTIFY THAT THE VEHICLENESSEL TO BE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HIGHWAYS/WATERWAYS OF THIS STATE.
I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED.
I CERTIFY THAT THIS MOTOR VEHICLENESSEL WAS REPOSSESSED UPON DEFAULT OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.
I/WE HEREBY CERTIFY THAT I/WE LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL, AND MAKE APPLICATION FOR TITLE. IF LIEN IS BEING RECORDED NOTICE IS HEREBY GIVEN THAT THERE IS AN
EXISTING WRITTEN LIEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY LIENHOLDER SHOWN ABOVE. I/WE FURTHER AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Signature of Applicant/Owner Signature of Applicant/Co-Owner
HSMV 82041 REVISED 02/06
IMPORTANT_ INFORMATION
SECTION 320.0605, Florida Statutes, requires this registration certificate or an official
copy or a true copy of a rental or lease agreement issued for the motor vehicle described be
in possession of the operator or carried in the vehicle while the vehicle is being used or
operated on the highways or streets of this state.
SECTION 316.613, Florida Statutes, requires every operator of a motor vehicle while
transporting a child in a passenger car, van or pickup truck registered in this state and
operated on the highways of this state, shall, if the child is 5 years of age or younger,
provide for protection of the child by properly using a crash -tested, federally approved child
restraint device. For children aged through 3 years, such restraint device must be a separate
carrier or a vehicle manufacturer's integrated child seat, for children aged 4 through 5 years,
a separate carrier or seat belt may be used. y `
SECTION 627.733, Florida Statutes, requires mandatory Florida No -Fault Insurance to
be maintained continuously throughout the entire registration period; failure to maintain the
Mail To: required coverage could result in suspension of your driver license and registration.
VILLAGE OF TEQUESTA FL Important note: If you cancel the insurance for this vehicle,
357 TEQUESTA DR immediately return the license plate from this registration to a Florida
TEQUESTA, FL 33469-3062 driver license or tax collector office or mail it to: Dept. of Highway
Safety, Return Tags, 2900 Apalachee Parkway, Tallahassee, FL 32399.
Surrendering the plate will prevent your driving privilege from being
suspended. `
CO/AGY 6 / 3 T# 608676308
,ORIDA VEHICLE REGISTRATION B# 960084
'LATE XC1138 DECAL Expires NO EXPIRATION
R/MK 2010/FRET BODY AM
'IN 1 FVACWDK2ADAP7206
late Type CVR NET WT 8919
rL/FEID -
rate Issued 1/6/2010 Plate Issued 1/6/2010
ILLAGE OF TEQUESTA FL
57 TEQUESTA DR
EQUESTA, FL 33469-3062
VR - CITY VEHICLES PLATE ISSUED X
COLOR YEL Reg. Tax 48.85 Class Code 97
TITLE 103623127 Init. Reg. Tax Months 12
County Fee 3.00 Back Tax Mos
Mail Fee Credit Class
Sales Tax Credit Months
Voluntary Fees
Grand Total 51.85
IMPORTANT INFORMATION
1. The Florida license plate must remain with the registrant upon sale of vehicle.
2. The registration must be delivered to a Tax Collector or Tag Agent for transfer to
a replacement vehicle.
3. Your registration must be updated to your new address within 20 days of moving.
4. Registration renewals are the responsibility of the registrant and shall occur during
the 30-day period prior to the expiration date shown on this registration. Renewal
notices are provided as a courtesy and are not required for renewal purposes.