ot TITLE No. 57 0745 4369 RESIDENT COUNTY. MONTGOMERY ‘ssuepate 03/31/2023 : ‘SALVAGE SALVAGE REPLACEMENT SALVAGE | DeNTFICATION WuMBER ven mae MAKE DESCRIPTION j| SXYKTDA11BG020253 2011 KIA KIA MOTORS CORP CONVERSION rmueace Boy TYPE ‘MODEL DESCRIPTION te) 192,772 UC SORENTO i i Geen m ACTUAL > Cu ‘comMeNTs PURCHASE PRICE exemeT i= ta $0.00 ic q 3 \ NOTATION(S) i & Fal EXPORT ONLY ° ae) | STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY oO (Wpt) «00 cuenoxee on CS (2)! DAYTON, OH 45417 oO 2) i EVIOUS OWNER(S 3 coy MESA L ADDINGTON gn & SCOTT A. ADDINGTON 3 2836 PARKWOOD DR 3A ‘TROY, OH 45373 o Bxyy = Patent ONLY —-S - u W L ‘** SALVAGE MOTOR VEHICLE - PURSUANT TO R.C. 4738.01. VEHICLE SHALL NOT BE OPERATED. VEHICLE MAY ONLY BE DRIVEN AS SPECIFIED IN R.C. 4505.11. ** WITNESS MY HAND AND OFFICIAL SEAL THIS 31ST DAY OF MARCH, 2023 %220699447 ICU MA Hed f Fobg %220699447 we EL OF ene BE SB Eas esi eeOeC Un Uae ACERT as on aes Pra prey atte Mceee et pi cae a, Pee RA el ti ea aERASURES AND ALTERATIONS VOID THIS TITLE ASSIGNMENT. (Type or print in ink) [ASSIGNMENT OF OWNERSHIP The vehicle was a(Fapplcable: [-] Law Enfowement Vente [-] Feed Verice [1] Taxi WARNING TO TRANSFEROR AND TRANSFEREE (SELLER AND BUYER) You are que ty law state ne te sling pres. A ase statement in Vote of secon 2521.13 ofthe Revised Code and is punishable by si merths'imprsenment or a tne of up to ene thousand dlrs, or Bath. All anlar are audted by the department of txaton ‘The ster and buyer must prove =F injrmaton requeted by the department of xa, The | oe may ee any aoa! tx tours to Be howot rovers poet i uc SO. Buyers) Printed Adcross —_ | (we) cortty tne veiclewatrratvouboard motor ceserbec ints ie was tansterted on ll Samana eoahe HO ied ber (ODOMETER CERTIFICATION: Federal end stato laws requite tht you state the mileage in connection with tansler of ownership. Fallure to complete or proving ale Foran nay rt in tesa penne Tw) hea crt ia toebest fy (ou) Komeage: dorete Reding Shek ore eae tone ot of be AFA), [ALA [A] mr mee (A re certs “ONLY, ; [LT odorter reading isn EXCESS oF 4 overs [Gl The oer ean i ot i actual mieage (09. Broken odometer ‘Seller is aminor ([] Yes [7] No it yes, BMV 3751 Form required: WARNING-ODOMETER DISCREPANCY, (oe) warrant gob eo at Sos State Farm Mutual Automobile | Stars Pete Hae 400 Cherokee Dr PE ‘a Sars Pred DAME, ONASETT taal Ste? Satire Wapato OH aire Pia ia te oy a a tim and atnoeetin my pena ie __ a of APR O 4 2023, in County, Stato of PATRICIA MANGEN Notary Public State of Ohio / Commission Expres Nov 30,2024 “Wy conmicon omnes | x ‘yer Printed Name Buyers Sgratre Sint ‘Re at tin ala tee oh Tan ames hy [APPLICATION FOR CERTIACATE OF TITLE (Type or print nink) {check Type ot Anpication(s): [[] Motor Venice] Momorarcum (] water [] cuitiéars ctor [] savage Apptean’s Printed Neme SSNEN. Co-Applicants Printed Name (tappscble) SSIvEN. | Aeplcants Printed Across Sioet iy Siae a County Purchase Price § exces Tax Due § Yondors Discount Texas Tax Exempt, state eason, Dealer Permit # Vondoc# Trade ns LIEN INFORMATION: itn0 Hen tao Tone W more than one len, atach statement of all adatoneliens == =~ Lonokdor Eien LWonholder Aires Condition of vehiclawatercrat/ouboard motor (check onlyone) [[] Good [J Far] Poor [] Wrecked ponte C] Yes C1) no With Right ot Survivorship [] Yes [] No Transteron Death [7] Yes [7] No it yes, BMV 3811 Forn required Aepeantisaminor [7] Yes [] No Mes, provide Date of Bith __/_)___ and BLAV 781 Form required x (wo) state tata information contained in this aplication I true and coract. AOcacanta Saglgn aad Sea cae ‘Go-Aonlcants Signature (i appicabie) wast sgn Reno Roan aharand Ofer) Scknontadpement by nary ‘Sworn to and subscribed in my presence ths Mey eeee in County, State of TNolary Public oF thar Aahorzed Oficer by aw “Wy conmsion oe LATE FEE OF $5.00 FOR FAILURE TO APPLY FOR TITLE WITHIN 30 DAYS OF ASSIGNMENT,