HomeMy WebLinkAboutVehicle Title_Truck_03/31/2015 1 1 1 1, 1 11 11 1 • • • � k 111 I 1.
1 11 1 � L •` -: �t '�`SY1` �� 35.� � r `�� � • 1 �;I 1j11
'a 11 �� F' y/ c SSS� r�p Rtd •� ^rt �' /\
f ^'
1 ,t�'r"s- � �'• . " r '} .�, }.�
'fie >• : �'`�. 'L .� .� ?' i 'r ���4 '�
5.�.
h.
r q .'+,w •` �� - .`''ells ;Pr
mc
+r? MARCH "3 ' 20 : 15
OD EHICLE IDENTIFICATION NO V DU 4 ' -Yi�
�FFW D3069
q �`r,r ,
d ,ri`2�< 52 FF r< '.r ,C• d YTYPE ..S S`, '}<lxs: x ..i` +'i .tAyg �`. f �.`' , [• 1
#' EG. CHAS
41 F4.50 4X4 R C ', asY ;
. 9 f 3'`b • : k r- qq�¢� C tY s+ ' .•
. G:V.W R ,
50.44 16500 LB , ,`'
NOMINAL TONNAGE
�;. s s R, F � . rte` c J 4 Y `•�3�t
{ a£ J `gy�• . y': fi y(�/' ¢r '�(�J` x7d� E �"It �, ,¢ae� 1. � ° l: ov 5'1
�. " � tq`s^ • � "` � ° "v� �> t 6 �M'C�# 4'S`�l� ? N e. e � 4 A �j �'�,� (..f '� \ g � �Y'S * j ) ° r !�#�' [ J'.
3,.i`x o.r g ;:: s2. "r .kGm!, f :.a �.. ♦•` Y
IN�ALIFORNIA 9 : r , 4 u._ . & 1
°�f'
sentative of the company f>rm or corporation named below, hereby c V
f. ove is the property of the said com.pany,firm or corporation and Is
tI' erthe:Involce Number Indicated?o fhe following distributor or depler
'
P.O. NUMBER TE UEST31 >60 S'
gv
� ��� .'rT ���� X `l � ', k �Y�'�C� G � ,9��$`.'L d Y / OM � , � X � f d '1� 4F "S / ��i�• �i '�_�
5t�a �-} f 1 }4 A ! } } � � Z ` '! * } � .4�VJ•Ss^" F F �.�
���� � < r•.� #; Tt �f•4��• +eh �x>, F} a `,"�` .3� � y��a '��� � *+„�' r ':
;d.
' F. FORD MOTOR COMPANY.: f s ¢
�h
HANG'
BRADLEY M GAYT SECRETARY ' { r
�1�r}, p � 1 � � I • �5.� V� y y ' �'f 2Jx lbr� S l / •. ♦`i X . � a 'it � ° 1 � C
f " j •£j .L { Ya >' .. . ``. C�' 'f m 11a'zi 3 •.� " a J, 'k''`�t'S F E
MICNT
y* f Y
IIIIIIIIIIII1111�1 �-��.�� �`
- 11111111111111111111111111111111IIIIIIIII111111111111IIIIIIIIIIILIIIIIIIIII�I .... -- ... F
Each undersigned seller certifies to the best of his knowledge, information and belief under penalty of law that the vehicle is new and has not been registered in
.. this or any. State at the time. of. delivery arrd vehicle is not subject to any secu7!ty,interests other than those disclosed herein and.warrant title to the vehicle.
FOR VALUE RECEIVED I TRANSFER THE:VEHICLE:DESCRI BED ON TI FACE OF - THIS CERTIFICATE TO
NAME A J U T1 1. GEE OFF �Q�� T A
W – PURCHASERS)
W ADDRESS �4- TFOUPSTA DID °S UE TFIXIESTA FL 33469 -0273
I certl#y to the best of my, o ed t the r reading) 16 N
'o Tenths
ftY.. 1 1
1 w DEALER : BY:
m NAME OF DEALERSHIP DEALERS LICENSE NUMBER Being duly sworn upon O at the statements set
State of
Z F1 forth are true and correct Subscribed and sworn to me
a �
before INS day of 20__._
Q County of a AW S; - NotaryPut3lic
USB NOTARIZATION ONLY. IF REQUIRED IN TITLING JURISDICTION
<v NAME OF =-
W M PURCHASERS)
o M ADDRESS
� � heertlfyto the best of�my::Knowtedge thattheodometer- reading i .. _ .., –.T..� NO Tenths
DEALER ul
NAME OF DEALERSHIP DEALER $,LICENSE NUMBER ..Being duly sworn upon oath says that the statements set
Z ::forth are #rue and correct. Subscribed and :sWornto me
sC try :Slate of
N before this day of � 20.—
p Q Eounty ; Not PubliC
USE NOTARIZATION ONLY RE IREO'N TITLING JURISD)CTIO
rS NAMEOF'
W PURCHASER(S)
w �' ADDRESS ,
• Z O � I certify to the best of my knowledge that the odometer reading is - No Tenths •
m DEALER NAME OF DEALERSHIP ' 9EALER$LICENSE NUMBER Baing d � sworn uponasth says that thesteternenfs set
2 forth are true and correct Subscribed and sworn to me .
tic � State of
01 before this day of 20
C Q 'County of Notary Public
U$E NOTARIZATION ONLYIF REQUIRED,N TITLING JURISDICTION
CTION
e NAME'OF:
l f?1QRCHASER(S)
_J W
• ug ADDRESS
z Z' I certrfy.to the..best of myknawledge that the odometer reading I6 No Tenths
... -._ :::
M
�� {3FJiLER NAME OF DEALERSHIP DEALERS LICENSE NUMBER Being du upon: oath says that the statements set
aGO State of forth are true and correct. Subserebeaandsworn t0 f e
y
before this day of20 •
•
31 Oounty of m' Nota y PubAc
USE:NOTANZATION ONLY IF REQUIRED INT1YlJNGJURISDICT ION
Federal J-�w requires you. to state jh3 L : odometer mileage in connectlon.with the transfer of ownermip. Failure do.complete or providing a false statement may result •
infines: and /or imprisonment,
¢ I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements Is checked. Odometer
Reading : No 7 The mileage stated is In excess of tts mechanical limits. 1:Tfio odometer readllig.ts not theaotual mileage.
b Q WARNING QTIOMETER lJtgCREPANCY
aN :.
Signature(s) xpf Sellers) Date of Statement : Date of Sale
p Being duly sworn upon oath says that the'statements set,
Printed Name(s) of Sellers(s) Dealers Noa forth: are true and:correci. Subscribed and swor.Imto me
W
w IX NgnatureO) of Purchasers) before this day:of 20—
O O
IL ` Ptinted Name(s) of Purchasers) 'Notary PUDIC
. 0 : CompanyName (If Applicable) State (A
:Address of Purchase r(s) County of
..:USE NOTARIZATION ONLY.-
REOUIRED 1N TITLING JURISDIOTION:
w �':i:st lien in favor
whose addresses c
2 N
Z 2nd lien in favor of
LU
whose address is w
FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION FOR CERTIFICATE OF TITLE WITH /WITHOUT REGISTRATION
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
I www.flhsmv.aovfDfflcesl
CHECK APPLICATION TYPE ORIGINAL I TRANSFER VEHICLE TYPE �� MOTOR VEHICLE 1_� MOBILE HOME �_� VESSEL OFF- HIGHWAY VEHICLE L_.� ATV El ROV I_ MC
UJ14 / APPLICANT INFORMATION
Customer Number Check this box if you are requesting Owns f Co -Ownef Unit Number Fleet Number
the certificate of title to be printed. t
Are you a Florida resident? ❑yes `._ pro r ❑d�yes Ono
Are you an alien? ❑yes C110 yes _ yes t no
OR L_ AND 1 NOTE: When joint ownership, please indicate d - or' or - and' is to be shown on title when issued. If neither box is checked, the title will be issued with "and.'
If applicable: �_y. -.I L fe EstatelRemainder Person Tenanc B the Entire (_J With Rights of Survworshi Owner's Coun of Residence:
Owner's Name As It Appears on Driver License (First, Full Micidte/Maiden. & Last Name) Owner's Email Address Date of Birth Sex FL Driver License or FEID /Suffix #
VILLAGE OF TEQUESTA
iCo-Owner/Lessee's Name As It Appears on Driver License (First. Full MiddlelMaiden. 8 Last Name) Co- Owner's /Lessee s Email Address Date of Birth Sex FL Driver License or FEID /Suffix #
1
Owner's Mailing Address (Mandatory unless a member of the Military) City Slate Zip
345 TEQUESTA DRIVE TEQUESTA FL 334G9-101273
Co- Owner's /Lessee's Mailing Address (Mandatory unless a member of the Military) C State Zip
Owner's /Lessee's Physical Street Address in Florida (Mandatory unless a member of the Military) City State Zip
i
Mobile Home Physical Address (if applicable) Check N in a mobile home rental park with 10 or more bb. Oily State Zip
Mad 7o Customer Name (If different From Above Owner) Mall To Customer's Email Address Date of Birth Sex FL Driver License or FEID /Suffix #
I - 7 Mad To Customer Address (If different From Above Marling Address) City State Lip
MOTOR VEHICLE MOBILE HOME OR VESSEL DESCRIPTION
VehicleNessel Identification Number Make /Manufacturer Year Body Color Florida Title Number i
1FDUF4HY5FED30693
F ORD 2015 CD I WHITE
revious State of Issue License Plate or Vessel Registration Number Weight Length BHP /CC GVW /LOC VAN USE, IF APPLICABLE
Ft In
❑ PASSENGER ❑ OTHER I
TYPE HULL MATERIAL PROPULSION FUEL 'DRAFT OF VESSEL
1 _1 Open Motorboat [ _J Houseboat [_] Personal Watercraft Q Wood L.] Aluminum 1 Outboard [.] Sail [_ ] Gas ( The depth of water a
[.] Cabin Motorboat [. i Pontoon (� Canoe f] Fiberglass [� Steel [_� Inboard (� Air Propelled [] Diesel vessel draws)
. J Auxiliary Sailboat I_.] Arboal L _� Other [ J Woodlfiberglass [.] Inboard /Outboard I_] Electric FT Speci IN
(] Inflatable [] Sailboat S fY [ ] Olhef (] Other [] Other
For all vessels 26' or more in
Specify Specify Specify lencith and all sailboats
USE OF VESSEL PREVIOUS
[ ] Recreational (Pleasure) I.7 Commercial Blue Crab [ ] Commercial Stone Crab (. ] Government [A Commercial Sponge OUT -OF STATE j
r ..
[ ] DealedManuf. ['] Commercial Fish ❑Commercial Live Bait [] Commercial Shrimp Recip. (. � Commercial Charter , -.� Commercial Other REGISTRATION NUMBER I
I ] Exempt L] Hire (Livery) [.] Commercial Mackerel [._] Commercial Shrimp Non - Recip. .] Commercial Oyster ('_J Commercial Spiney Lobster
Previously Federally Documented Vessel, Attach Copy of: State of Principal Use
U S Coast Guard Release From Documentation Form: or �_1 Copy of Canceled Documentation Papers
BRANDS USAGE AND TYPE iCheck Applicable Boxes
SHORT TERM LEASE _]LONG TERM LEASE [ _]REBUILT ❑POLICE VEHICLE _]PRIVATE USE TAXI CAB [FLOOD (�ILEV ( ]CUSTOM
'ASSEMBLED FROM PARTS f _]80NDED TITLE [ IKIT CAR (;GLIDER KIT (_;MANUF BUY BACK J ]REPLICA [ _iAUTONOMOUS (_ 'ELECTRIC ;STREET R9D'
LIENHOLDER INFORMATION
CHECK I FEID # Date of Lien Lienholder's Name
_.] (.] DL #and Sex and Date of Birth [J DMV Account #
IF ELT
CUSTOMER
Lienholder's Email Address Lienholder's Address City State Zip
If Lienholder authorizes the Department to send the motor vehicle or mobile home title to the owner, check box and countersign:
(Does not apply to vessels). If box is not checked, title will be mailed to the first Lienholder. (Signature of Lienholder's Representative)
5 1 TRANSFERTYPE
IF OWNERSHIP HAS TRANSFERRED, HOW AND WHEN WAS THE VEHICLE, MOBILE HOME, OR VESSEL ACQUIRED?
( J SALE 7j GIFT REPOSSESSION I COURT ❑ OTHER (SPECIFY) DATE ACQUIRED
g 7 ODOMETER DECLARATION
WARNING' Federal and State law reauires that You state the mileaoe in connection with an application for a Certificate of T6, Failure to complete or providing a false statement may resuR in Flnes or imorisonmed
IMIE STATE THAT THIS I -] 5 OR ❑ 6 DIGIT ODOMETER NOW READS ❑ [] ❑ f ❑ ❑ a .XX(NO TrNTHS) MILES, DATE READ _ I_ I AND IMlE HEREBY CERTIFY
THAT TO THE BEST OF MY/OUR KNOWLEDGE THE ODOMETER READING:
1. REFLECTS ACTUAL MILEAGE. FJ 2. IS IN EXCESS OF ITS MECHANICAL LIMITS. 3 IS NOT THE ACTUAL MILEAGE.
DEALER SALES TAX REPORT AND VEHICLE TRADE IN INFORMATION (IF APPLI
FLORIDA SALES TAX REGISTRATION NUMBER DATE OF SALE DEALER LICENSE NUMBER AMOUNT OF TAX AL ENT SI NATURE
38- 130137145239 1 VF10 861
YEAR OF TRADE IN MANE OF TRADE IN TITLE NUMBER OF TRADE IN (IF KNOWN) VEHICLE IDENTIFICATION NUMBER OF TRADE IN
HSMV 82040 — REV. 12/12 www.fihsmv.aov
MOTOR VEHICLE IDENTIFICATION NUMBER VERIFICATION
THIS SECTION REQUIRES A PHYSICAL INSPECTION AND A VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER VL. IN) ( THE MOTOR NUMBER FOR MOTOR VEHICLES MANUFACTURED
PRIOR TO 195 5 ) OF THE MOTOR VEHICLE DES ON THIS FORM BY A LICENSED DEALER, FLORIDA NOTARY PUBLIC, POLICE OFFICER, OR FLORIDA DIVISION OF MOTOR VEHICLES
EMPLOYEE OR TAX COLLECTOR EMPLOYEE. IF THE VIN IS VE RIFIED BY AN OUT OF STATE MOTOR VEHICLE DEALER THE VERIFICATION MUST BE SUB MITTED ON THEIR LETTERHEAD
STATIONERY. COMPLETE THIS SECTION ON ALL USED MOTOR VEHICLES, INCLUDING TRAILERS, (WITH ABBREVIATION OF TL' WITH A WEIGHT OF 2,000 POUNDS OR MORE) NOT CURRENTLY
TITLED IN FLORIDA.
I, the undersigned, certify that I have physically inspected the above described vehicle and find the vehicle identification number to be:
(Vehicle Identification Number)
DATE SIGNATURE PRINTED NAME
Law Enforcement Officer or Florida Dealer /Agency Name Badge # or Florida Dealer # Notary Stamp or Seal
FL DMV/Tax Collector Employee Florida Compliance Examineriinspector Badge or ID Number
COMMISSIONED NAME OF FLORIDA NOTARY: NOTARY'S SIGNATURE
(Print, Type or Stamp)
9 SALES TAX EXEMPTION CERTIFICATION
THE PURCHASE OF A RECREATIONAL VEHICLE TO BE OFFERED FOR RENT AS LIVING ACCOMMODATIONS DOES NOT QUALIFY FOR EXEMPTION. I CERTIFY THE RECREATIONAL VEHICLE, MOBILE HOME OR VESSEL DESCRIBED HAS
BEEN PURCHASED AND IS EXEMPT FROM THE SALES TAX IMPOSED BY CHAPTER 212, FLORIDA STATUTES, BY:
❑ PURCHASER (STATE AGENCIES. COUNTIES, ETC.) HOLDS VALID EXEMPTION CERTIFICATE CONSUMER'S CERTIFICATE OF EXEMPTION NUMBER
❑ MOTOR VEHICLE ❑ MOBILE HOME ❑ VESSEL WILL BE USED EXCLUSIVELY FOR RENTAL
SALES TAX REGISTRATION NUMBER
I hereby certify that ownership of the motor vehicle, mobile home or vessel described on this application, is not subject to Florida Sales and Use Tax for the following reason: ❑ INHERITANCE [J GIFT
DIVORCE DECREE []TRANSFER BETWEEN HUSBAND AND WIFE u EVEN TRADE OR TRADE DOWN (State the facts of the even trade or trade down and the transferor information, including
the transferor's name and address, below under "Other: Explain. ")
t_J OTHER: (EXPLAIN)
REPOSSESSION DECLARATION
IF CHECKED, THE FOLLOWING CERTIFICATIONS ARE MADE BY THE APPLICANT:
❑ I CERTIFY THAT THIS MOTOR VEHICLE, MOBILE HOME OR VESSEL WAS REPOSSESSED UPON DEFAULT IN THE TERMS OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.
❑ (VESSEL) A PHOTOCOPY OF THE LIEN INSTRUMENT FOR THE VESSEL IS REQUIRED AND ATTACHED.
t ) I AM REQUESTING THAT AN ORIGINAL CERTIFICATE OF REPOSSESSION BE ISSUED FOR THE MOTOR VEHICLE OR MOBILE HOME IN LIEU OF A TITLE (REPO SSESSiON).
❑ I AM REQUESTING THAT A DUPLICATE CERTIFICATE OF REPOSSESSION BE ISSUED FOR THE MOTOR VEHICLE OR MOBILE HOME, AS THE ORIGINAL HAS BEEN LOST OR DESTROYED.
NONUSE AND OTHER CERTIFICATIONS
IF CHECKED, THE FOLLOWING CERTIFICATIONS ARE MADE BY THE APPLICANT:
❑ 1 CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED.
❑ THE VEHICLE IDENTIFIED WILL NOT BE OPERATED ON THE STREETS AND HIGHWAYS OF THIS STATE UNTIL PROPERLY REGISTERED.
❑ THE VESSEL IDENTIFIED WILL NOT BE OPERATED ON THE WATERS OF THIS STATE UNTIL PROPERLY REGISTERED.
❑ OTHER: (EXPLAIN)
APPLICATION ATTESTMENT AND SIGNATURES
I /WE PHYSICALLY INSPECTED THE ODOMETERNIN AND FURTHER AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS. (More than one form HSMV 82040 may be used for additional signatures )
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) Date SIGNATURE OF APPLICANT (CO.OWNER) Date
RELEASE OF SPOUSE OR HEIRS INTEREST
The undersigned person(s) state(s) as follows: That died on
(Name of Deceased) (Date)
® testate (with a will) intestate (without a will) and left the surviving heir(s) named below.
[] When applicable, the heir(s) (named below) certifies that the certificate of title is lost or destroyed.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
(More than one form HSMV 92040 may be used for additional Mnatures )
Print or Type Name of Spouse, Co -owner or Heir(s) Signature of Spouse, Co-Owner or Heirs)
That at the time of death the decedent was owner of the motor vehicle, mobile home or vessel described in section 2 of this form. The person(s) signing above hereby releases all of his /her /their right, title, interest and claim as
heir(s) at law, legatee(s), devisee(s), or otherwise to the aforesaid motor vehicle, mobile home or vessel to:
Name of Applicant(s) (Print or Type)
RESIDENTS OF FLORIDA AND ALL VESSEL OWNERS, RESIDING IN FLORIDA OR OUT OF STATE, SHOULD SUBMIT THIS FORM AND ALL REQUIRED DOCUMENTATION TO
A LOCAL FLORIDA TAX COLLECTOR'S OFFICE OR THE FLORIDA TAX COLLECTOR'S OFFICE LOCATED IN THE APPLICANT'S COUNTY OF RESIDENCE FOR
PROCESSING.
Check your local phone book government pages or visit the fallowing website for current mailing addresses: hftp://www.flhsmv.ciov/offlces/
www.fthsmv,gov
HSMV 82040 — REV. 12/12
t �i,, �,V, �tw,�,, k ��
AFFIDAVIT
THE UNDERSIGNED HEREBY CERTIFIES THE FOLLOWING FACT REGARDING VEHICLE DESCRIBED:
MAKE YEAR VIN# TITLE# TYPE
1 MY NAME WAS ENTERED IN ERROR AS PURCHASER ON THE ABOVE TITLE. I HAVE NEVER TAKEN
POSSESSION OR HAD ANY INTEREST IN THIS VEHICLE,
2 MY NAME WAS ENTERED IN ERROR AS LIENHOLDER ON THE ABOVE TITLE, I DO NOT HOLD ANY
LIEN AGAINST THIS VEHICLE.
3 THE ABOVE TITLE REGISTERED IN THE NAME OF HAS BEEN
LOST OR DESTROYED. A DILIGENT SEARCH HAS BEEN MADE BUT TITLE CANNOT BE LOCATED.
4 THE NAMES AND SHOWN
ON THE ATTACHED DOCUMENTS IDENTIFY ONE AND THE SAME.
5 THE ABOVE VEHICLE WILL NOT BE DRIVEN ON THE PUBLIC HIGHWAYS OF FLORDIA.
6 THE ABOVE DESCRIBED VEHICLE HAS NOT BEEN OPERATED UPON THE PUBLIC HIGHWAYS OF FLORIDA
SINCE
7 THE ABOVE DESCRIBED RECREATIONAL VEHICLE HAS BEEN MAINTAINED IN DEAD STORAGE.
8 THIS IS TO CERTIFY THAT I PAID FOR THE ABOVE
VEHICLE AND THE SELLER CANNOT BE LOCATED TO ATTEST TO THE SELLING PRICE.
9 THIS IS TO CERTIFY THAT THE ODOMETER IS BROKEN ON THE ABOVE DESCRIBED VEHICLE AND
SELLER CANNOT BE LOCATED TO VERIFY MILEAGE.
10 PLEASE MANUALLY PLACE THE FOLLOWING NAMES ON TITLE
11 \\ PHYSICAL DELIVERY /PURCHASE DATE OF VEHICLE DIFFERS FROM INVOICE & TITLE APPLICATION DATES, PLEASE USE
7 - d - T 1 ) `� AS ACTUAL DELIVERY /PURCHASE DATE FOR TAG & TITLE PURPOSES.
12 MILEAGE REFLECTED ON MSO /COV IS NOT CORRECT. ACTUAL MILEAGE OF VEHICLE SHOULD READ
NO FRAUD INTENDED.
13 OTHER
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING
DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE AND CORRECT.
S NATURE
PURCHASE ORDER
VILLAGE OF TEQUESTA
345 Tequesta Drive • , • , _ •
Tequesta, Fiorida 33469 -0273 P.O. NUMBER
(561) 768 -0700 Fax (561) 768 -0699 10/02/2014 1111412014 00003160 1
VENDOR 00701
NO.:
•��
ALAN JAY FORD LINCOLN MERCURY WATER TREATMENT PLANT
3201 US HWY 27 SOUTH VILLAGE OF TEQUIESTA
SEBRING, FL 32870. 901 NORTH OLD DIXIE HIGHWAY
TEQUESTA, FL 33469
SHIP VIA: ORDERED BY: NATHAN LITTERAL
F.O.B.: P.O. TYPE: Regular
TERMS:
ACCT. NO.:
DESCRIPTION: REPLACMNT FOR UTILITY BED..PRI
FL STATE SALES TAX EXEMP. CERT. # 85.801663307OC -7
1.000 2015 FORD F -540 REG CAB CHASSIS 74,794.3000 74,784.30
TOTAL: $ 74,784.30
401 - 411 - 564.602 Vehicles 74,784.30
PURCHASE ORDER NUMBER MUST APPEAR APPR VED
ON ALL INVOICES, PACKAGES, AND BY
SHIPPING DOCUMENTS.
DELIVERIES WILL BE ACCEPTED MONDAY
THRU FRIDAY 8:30 AM - 4:00 PM
Au orized Signature
FW A , .- ---- • FFED30693
W-" - XO-w7 r
--- DATE 12-Apr-15
Toll Free800-252-6529 Direct 863-402-4234
SOLD T O STATE BID NUMBER
TEQUESTA, VILLAGE OF 071-000-14-1
STREET ADDRE"IC-S SPECIFICATION NUMBER (if applicable)
345 TEQUESTA DRIVE SPECIFICATION # 071-562-002 Line: 854
CITY TA'E
TEQUESTA FL 33469
........................... I .................. I ......................... ............ ............
PHONE NUIABER
561-262-4341 Florida State Term Contract No.
rty•. >A ES TAX EXEMPTION w 071-000-14-1
85-8015833079C-7 Motor Vehicles
TOMIER PURCHASE OR
,- UG http://www.myfloridamarketplace.com
3160
YEAR MAKE MODEL NEW/USED KEY CODE ORDER # SALESPERSON i
2015 FORD F4H NEW WILSO
�VIN DESCRIPTION SALE
BASE PRICE 30,590.50
175 AMP ALTERNATOR 0.00
EXTERIOR COLOR OXFORD WHITE W1 STEEL CLOTH
INTERIOR Z1 3S 199.00
4:88 AXLE RATIO LIMITED SLIP REAR DIFFERENTIAL X81- 360.00
POWER WINDOWS/LOCKS/MIRRORS/REMOTE KEYLESS 90L 0.00
DAYTIME RUNNING LAMPS 942 4400
CENTER HIGH MOUNT STOP LAMP (CHSML) 59H 0.00
ELECTRONIC SPEED CONTROL AND TILT STEERING 525 0.00
POWER SCOPE POWER TELESCOPING TRAILER TOW
MIRRORS 54F 165.00
MODEL YEAR 2015 QUOTED ON 2014 CONTRACT MY[ 801.00
FACTORY OPTIONS
(QUOTED ON ALAN093556) 0.00
TEMPORARY TAG TEMP 0.00
DOMINATOR 9'MEID DUTY CRANE BODY WITH
STANDARD RIGHT REAR CRANE MOUNT. 14" STEP
BUMPER WITH INTEGRATED STORAGE, FULLY
INTEGRATED AND SEALED ELECTRICAL SYSTEM WITH
60" CA, CHASSIS SPRING BUILDUP, AND 10" FOLD DOWN
TAILGATE. HORIZONTAL COMPARTMENTS OVER WHEEL
WELLS WITH FOLD DOWN STYLE DOORS- DSCS20 39,300.80
IMT 4004i 18K FT-LB 360 DEG ROTATING CRANE WITH
TETHERED REMOTE AND BOOM REST 4004i 0.00
HID TRAILER TOW PACKAGE WITH DRAW BAR, 2-5/16"
BALL, PIN, AND CLIP CLIVWC 0.00
(5) COMPARTMENT LIGHTS (2) FLOOD LIGHT CLIFL 0.00
MASTER LOCKING SYSTEM MLS 0.00
RAISED FRONT COMPARTMENT WITH (2) TANK BRACKET
& STANDARD SHELVING PACKAGE. RFC 0.00
CAB SHIELD HAIR 0.00
VICE MOUNTING BRACKET & 6" WILTON TRADESMEN
VICE VMP 382.00
CQNTRACT 0P.T110 39.682.80
(2) WHELEN M4D LIGHT HEADS WITH BLACK FLANGE (1)
MOUNTED ON EACH SIDE OF UTILITY BODY OVER
WHEEL WELLS. (AMBER / CLEAR). M4 575.00
(2) WHELEN TIR3 LIGHT HEADS MOUNTED TO REAR OF
UTILITY BODY W-TIR3 364.00
WHELEN GRILLE LIGHTS (AMBER) W-GL 332.00
UPGRADE TO 2-5/16" BALL / PINTLE COMBO PINTLE 169.00
UTILITY BODY SPRAY ON BED LINER IN CARGO AREA TO
INCLUDE TOPS OF BOXES AND BUMPER USOB-T 974-00
WHELEN FOUR CORNER LED KIT W-VERTEX 521.50
EXTENDED WARRANTY DECLINED 1 0.001
NON- IDENTIFIED CONTRACT 0PT1ONS 2.935,5J
DESCRIPTION OF TRADE IN
000
REMIT PAYMENT TO:
Allan Jay Ford Lincoln FEID #
Mercury, Inc.
FLORIDA BATTERY & TIRE FEE $6.50
P.O. BOX 9200 20-5996360 SALES TAX EXEMPT
,SEBRING, FL 33871-9200
TOTAL $74,784.30
STATE-TEQUESTA, VILLAGE OF-F4H_1695-1
IMPORTANT_ INFORMATION
SECTION 320.0605, Florida Statues, 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 Statues, 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 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.
SECTION 627.723, Florida Statues, requires mandatory Florida No -Fault Insurance to
be maintained continuously throughout the entire registration period; failure to maintain the
required coverage could result in suspension of your drivers license and registration.
Mail To:
Important note: If you cancel the insurance for this vehicle,
VILLAGE OF TEQUESTA immediately return the license plate from this registration to a Florida
345 TEQUESTA DR drivers license or tax collector office or mail it to: Dept, of Highway
Safety, Return Tags, 2900 Apalachee Parkway, Tallahassee, FL 32399,
TEQUESTA FL 33469 Surrendering the plate will prevent your driving privilege from being
suspended.
CO /AGY 69/03 T# 864322951
B#
FLORIDA VEHICLE REGISTRATION
PLATE BLI4759 DECAL EXPIRES MIDNIGHT THU 8/20/2015
YR/Mg 2015 /FORD BODY CB COLOR WHI Reg.Tax 2.00 Class Code 13
VIN 1 FDUF4HY5FED30693 TITLE Init. Reg. Tax Months
Plate Type TDL NEW WT 7312 County Fee Back Tax Mos
Mail Fee Credit Class
DL /FEID Sales Tax Credit Months
Date Issued 7/22/2015 Plate Issued 7/22/2015 Voluntary Fees
Grand Total 2.00
IMPORTANT INFORMATION
VILLAGE OF TEQUESTA 1. The Florida license plate must remain with the registrant upon sale of vehicle.
345 TEQUESTA DR 2. The registration must be delivered to a Tax Collector or Tag Agent for transfer
to a replacement vehicle.
TEQUESTA FL 33469 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 newel purposes.
TDL - DEALER ASSIGNED TEMPORARY LICENSE PLATE PLATE ISSUED BLI4759
L/►W ODOM -103 -N
V I I I AGE OF TEDI TED 1 STA FFED30693 _
CUSTOMER'S NAME STOCK NO.
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
result in fines and /or imprisonment.
I, Al AN .TAY FORD (transferor's name, Print)
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 described below,
unless one of the following statements is checked.
❑ (1) 1 hereby certify that to the best of my knowledge the odometer reading
reflects the amount of mileage in excess of its mechanical limits.
❑ (2) I hereby certify that the odometer reading is NOT the actual mileage.
WARNING - ODOMETER DISCREPANCY.
MAKE MODEL BODYTYPE
FORD F450 CB
VEHICLE IDENTIFICATION NUMBER YEAR
,r� MF11IHYTPED30693 201
T Z EROR'S SIGNATURE
ALAN JAY FORD
PRINTED NAME
3201 US HIGHWAY 27 SO.
TRANSFEROR'S ADDRESS (STREET)
SEBRING, FL 33870
CITY STATE ZIP CODE
DATE OF STATEMENT
X
TRANSFEREE'S SIGNATURE
PRINTED NAME
VILLAGE OF TEQUESTA
TRANSFEREE'S NAME
345 TEQUESTA DRIVE
TRANSFEREE'S ADDRESS (STREET)
TEQUESTA FL 33469 -0273
CITY STATE ZIP CODE
Lnw® FORM NO.ODOM -103 -N (REV. 3/13)
®2013 The Reynolds and Reynolds Company TO ORDER: x .reysource.com; 1- 800.3440996; tax 1.800- 531 -9055
THE PRINTER MAKES NO WARRANTY, EXPRESS OR IMPLIED, AS TO CONTENT OR
FITNESS FOR PURPOSE OF THIS FORM. CONSULT YOUR OWN LEGAL COUNSEL.