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HomeMy WebLinkAboutVehicle 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 �-- !denl5 !lamb Y'ar dike Bally Vv-1 L i*iF 1FVACWDK2ADAP7206 12 FRET AM jT 891 Nte T 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.