i 1 STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE wo them aoviofices i i vn | *’ Notice of Sale and/or Bill of Sale for a Motor Vehicle, | Mobile Home, Off-Highway Vehicle or Vessel Notice of Sale (Seller must complete sections 1 & 3). The purchaser's signature in 28ction 3 is optional, Bill of Sale (Seller and purchaser must complete sections 1, 2 (when applicable) & 3) i Motor Vehicle, Mabilo Home, OF Highway or Vessel Description J Year ‘Make/Manufacturer | Body Type Modat pee 2004 Gnag. daly Pr cisekl slver poi er chro Near 2029S G9 L3CPFEYISGS4 7 37F66 {two co hereby sell or have sold and doliverad the above described motor vahi-!® Moblis home, offthichway vohlcle or vessel to: enero of Prcosera) BSc que ya TKI. EMO Ea de mena ne cy eo éoas (331 Murchison tien €d-_ Sanford NC 37335 | ore f ane vr" = -.'3 000 . ‘2. Odometer Disciosure Statement (Required For a Motor Vehicle) Federal and State law requires that you stato tho mileage in connection withthe transfar of ownership. Follae to | 2mPlete or providing a false statemont may result in Mion ‘Imprisonment. | WESTATE THAT THs MoTOR vEntcle's ||” soir on Y6o1err ooomeTeR now neADs [2]KC] fe). ANI Ean thorensis es, care nea _OY 11 /S 1 1S” Ato we Henenycenrie mar 10 TH eo oF Ons Coo | "HE oD0METER READS 2. ISINEXCESS OF ITS MECHANICAL UMTS. 31S Nur‘vitE|AC"TAL_wn EAGE. i : ISS ! Certification UNDER PENALTIES OF PERJURY, {DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS [STATED INT ARE TRUE. : 3 sare i = _lPeébect 2y aor Satin “hid is * a Sy a > e Zp [reset dec I ‘Ge Baars Aare (when applicablay———— ory Ta Gptode aa yaaa ‘Baie 4—(p-201S> oR : + OWNERSHIP STATUS FOR THE ABOVE DESCRIBED MOTOR VEwLE-WOBILE HOME, OFF mtGnWAY VEWGLE OR vEasec ILL NOT CHANGE UNTIL THE PURCHASER APPLIES FOR AND IS ISSUED A CEAMIFIGATE OF THU, CHeck your local phone book government pg iattsit the following website for current mailing addresses: http:/www/finsmv.qov/offices Ege SEXHET HSH ez0s0 Rev on) 8 Sen