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HomeMy WebLinkAboutVehicle Title_Truck_12/02/2003' [;'VESSEL LE ~ ION _ REPORT# i DECAL NUMBER DECAL BIRTHDATE EXPIRES TRANS INSURANCE PLATE RESIDENT coulvrY DATE OF ISSUE pIATE NUMBER OR FLORIDA # YR. ISSUED SIX MD. DAY YF?R MD~ ~ Plm I^ = ALIEN ~ MO~ '. (~ Cf ~~(,'~ t)~ 1_' - TITLE NUMBER VEHICLE /VESSEL IDENTIFICATION # YR. MAKE MAKE ar MANUFACTURER BODY TYPE CLASS Wi /LENGTH GVW I LOC !i;~~~~ ~ .., ~~~ ? Fmr M'1.-~`'^`~~. ~'~~.'-~~ .:.'~lllc rn~,r, ~j'~' ~ 5^ ~~ HULL MATERIAL PROPULSION FUEL VESSEL USE VESSEL TYPE WATER ccDE VEHICLE COLOR 1st OWNER FL I DL# OR FE.I.D.# LBIJ CF.YI - , 2nd OWNER FL I DL# OR UNIT # Applipnt /Owners Name 6 Address ~IILLAGE '~?~' TEQUE Tr', voLUNTARYCONTRIBUnoNS: • 35? TF'GtUT_?~TP. DID • CREDIT VEHICLE FLEET NUMBER LAS MOS. REG. FEE i`l :; (; iYt to t`l . '(. INIT REG. AGENCY FEE ~ ~ . 7 ~ MAIL FEE ~:^t , Ill TITLE FEE SALES TAX GRAND TOTAL ~ 7 . ~., '; ~J . i:11.. ~ l _ '7 i- _f.x-~13 I` ~.l"~ L Action Requested: Brards: STATE PREY. REG. QATE AC„QUIt~D ~,- i:_ :'::.'(i0f N USED O ETE / E OF CTURER DQ;?, ~1~~ ~I:~18 % ~0~3 ACTUAL LIEN INFORMATION ~ DATEOFLIEN LIENHOLDER: (IF NO LIEN, ENTER NONE) ~..,..~. fE1D # OR FL / DL # AND SEX AND DATE OF BIRTH ODOMETER DECLARATION CERTIFICATION VEHICLE USE: FF I V ATE CITY SELLER INFORMATION NAME OF SELLER, FLORIDA DEALER, OR OTHER ADDRESS: DEALER LICENSE NO. SALES TAX AND USE REPORT TRANSFER OF TITLE STATE ZIP CODE STATE ZIP CODE CONSUMER OR SALES TAX EXEMPTION # IS EXEMPT FROM ^ PURCHASER HOLDS VALID INDICATE TOTAL PURCHASE PRICE, INCLUDING ANY FLORIDA SALES OR EXEMPTION CERTIFICATE UNPAID BALANCE DUE SELLER, BANK OR OTHERS S USE TAX FOR THE REASON(S) CHECKED ^ VEHICLENESSEL WILL BE USED INDICATE SALES OR USE TAX DUE AS PROVIDED BY EXCLUSIVELY FOR RENTAL CHAPTER 212, FLORIDA STATUTES $ ~ ' ~~ ' OTHER --:,, L r ~ SELLING PRICE VERIFIED APPLICANT CERTIFICATION ^ INVE 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. INVE HEREBY CERTIFY THAT IM/E 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. INVE 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 ApplicanUOwner Signature of Applicant/Co-Owner ~ HSMV 82041 (REV. 07/02) 5 OWNER COPY .; .. .. ... .. .. . ,<. < .a ,r r, .... :.. ......w .. . . ... ,w,...,, o .... .w..........„ ........ ,., ,....x ... ... ,. u,..~Yt~ ..x,.,W arasaN _ _ ____1 STATE OF FLORIDA ~ DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTOR VEHICLES Neil Kirkman Building -Tallahassee, 32399-0500 MOTOR VEHICLE DEALER TITLE REASSIGNMENT SUPPLEMENT (Instructions on Reverse Side) For use by licensed MOTOR VEHICLE DEALERS. AUCTION DEALERS and THEIR BUYERS ONLY This reassignment is supplement to: ^ Title No.: State of Issue: Manufacturer's Statement or Certificate of Origin VEHICLE DESCRIPTION Vehicle Identification Number Year Make Model Body W14 CC REASSIGNMENT INFORMATION Name of Selling Dealer (Print) Dealer License Number State of License VF672 FL Street ddress City State Zip Code JACKSONVILLE FL 32225 Sales Tax Collected Sales Tax Reg. No. (Sales Tax Information is not required on dealer to dealer transactions) $ -08-01912-23 Buyer's Name(s) Date of Sale GE OF TE UESTA 18 NOV 2003 Buyer's Address City State Zip Code TE UESTA FL 33459 Auction Name (If applicable) Auction License Number State of License Date of Auction Street Address City State Zip Code ODOMETER DISCLOSURE STATEMENT WARNING: FEDERAL AND STATE LAW , EQUIRE THAT YOU STATE THE ODOMETER MILEAGE IN CONNECTION WITH TRANSFER OF OWNERSHIP. FAILURE TO COMPLE~E OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT. NNnnvv ~g p3 i 0 I STAT£TF~AT TI-RSMOTIy~"VEHICLE'S ^ 5 DIGIT OR ^ 6 DIGIT ODOMETER NOW READS ^^^,^~© xx (NO TENTHS) MILES, DATE READ _ _! _/_ _ ,AND TO THE BEST OF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE DESCRIBED IN THIS DOCUMENT UNLESS ONE OF THE FOLLOWING IS CHECKED• CAUTION: READ CAREFULLY ~ 1. I HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, THE ODOMETER READING REFLECTS THE BEFORE you AMOUNT OF MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS CHECK A BOX ^ p, HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE. WARNING -ODOMETER DISCREPANCY SELLER AFFIRMS, UNDER PENALTY OF PERJURY, THAT THE ABOVE FACTS ARE TRUE AND CORRECT TO THE BEST OF HIS/HER KNOWLEDGE Dealer's Agent Printed Name (Selling Dealer) Dealer's Agent Signature MIK DAVIDSON PORD Buyer' Si nature (1) Ackno}vledge Receipt of Statement Buyer's Signature (2) Acknowledges Receipt of Statement . i - 1 // Buyer's Printed Name (1) First, Full Middle or Maiden, Last Buyer's Printed Name (2) First, Full Middle or Maiden, Last VILLAGE OF TEQUESTA Street Address City State Zip Code ~ 7 TE UESTA DR TEQUESTA FL 33469 NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS ASSIGNMENT AND ALL ASSIGNMENTS THAT FOLLOW. FILE: -ORIGINAL: WITH TITLE COPY: DEALER RECORD HSMV 82994 (REV. 01/02) S ~NHO IS AUTHORIZED TO COMPLETE THIS FORM?: Licensed Motor Vehicle Dealers, Auction Dealers and their purchasers. vNHEN SHOULD THIS FORM BE USED?: Form HSMV 82994, Motor Vehicle Dealer Reassignment Supplement, must be -- used by dealers, auctions, etc.: . 1. with conforming Florida Certificate(s) of Title to make additional dealer reassignments and odometer disclosures where all reassignment and odometer disclosure spaces on the reverse side of the Certificate of Title have been used; or 2. with non-conforming Certificate(s) of Title to make reassignments and odometer disclosures; or 3. with conforming MCO, when the MCO is not available at the time of sale; or 4. with all out-of-state non-conforming Certificate(s) of Title to make dealer reassignments and odometer disclosures. V'VHEN SHOULD THIS FORM NOT BE USED?: 1. Is ten (10) years old or older. 2. Has a Gross Vehicle Weight Rating (GVWR) of more than 16,000 pounds. 3. Is not self propelled. Note: If a reassignment form is needed for an exempt vehicle (see above list of exemptions}, use form HSMV 82091. FILING: 1. The original HSMV 82994 is to be attached to the Certificate of Title or Manufacturer's Certificate of Origin surrendered with the application for title. 2. The copy of the HSMV 82994 is to be retained by the dealer in his/her records for a period of five (5) years. Note: If the motor vehicle is being sold to an out-of-state purchaser or an out-of-state deafer, the Florida dealer must photocopy the completed original of this. form and mail directly to the department within five (5) business days after the transfer.