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<br /> MOTOR VEHICLE DIVISIONi 1�
<br /> � ND OEPT.OF TRANSPORTATION y,
<br /> � CERTtFICATE OF TITLE FOR A VEHICLE n 6pBE'BDULEVARDAVENUE
<br /> NORTH DAKOTA DEPARTMENT OF TRANSPORTATION � + . ; •:
<br /> �„? R. •� �r, BiSMIq(tCK,`.N038505-0780 , �
<br /> � SFN 2875(Rev.01-a 1) � ; „=t� :�-' ,r�i PHONE(7D1�'32&2725,s,' ,� �
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<br /> YEAR 1fEAR � ' �f � •"�, w 1 j�,+.' =�`7 .irE` ,.
<br /> ta VlN MODEL REGISTERE� �►� °s�BODY�STYI.E ' � MODEI�^ ��
<br /> � �IN036434� `` 2012 MANSIO 8880 �*
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<br /> � OWNER(SI NAME " ''1s; .�, C:�, .F
<br /> HANCOCK CONCRETE PRODUCTS LLC•, TITLE NUMBER*� VEHIGL�T1fPEy SHIPWNG 1N�16HT DATE ISSUED '
<br /> 6702211 , ;°°` 'fRAiLER �-.-' � Y�: p�'� ;:.4' 07-16-2012 '
<br /> Ma��To . :a, � . , • .,. . . . .
<br /> 237
<br /> ODOMETER STATUS
<br /> HANCOCK CONCRETE PRODUCTS LLC' � ���
<br /> 17 ATLANTIC AVE � ,
<br /> HANCOCK MN 56244-9715 �
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<br /> '; PART 1. ASSIGNMENT AND WARRANTY OF TITLE(DELIYER TITLE TO BUYER WITHIN 75 DAYS FROM DATE dF 5ALE)
<br /> �� Applicant's Legal Name(ficst,middle,last)or Firm Name(Lessor,Trust}: �j OL�CID[�CORPID[]FEIN(Check One•Telephone Number
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<br /> � MailingAddress City State .; ' Zip, � Counry
<br /> i� . . _ ,.,� ' . ;
<br /> ij Co-ApplicanYs Legal Name(first,middle,last)or Firm Name(Lessor,Trust): �DL�CID 1]CQRP)CQ FEIN(�e�Ox)Telephone Number �
<br /> �
<br /> �� Mailing Address City State • Zip ,: County
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<br /> `� Check one: Date of Sale Selling Price
<br /> j ❑ Or ❑ And ❑ AndlJoint Tenants with Right of Survivorship � •
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<br /> �: Odometer.Compiete if vefiicle i5 less than ten{10j years old.
<br /> ;j I certify the odorneter reading is the actual vehicle mileage unless one of the following statements is checked:
<br /> j [� Mileage stated is in excess of its mechanical limits. ❑ Odometer reading is not the acfual miteage(vvarning"odometer discrepancy). s
<br /> 9 �
<br /> � �(a'n-etur�o'SeiEa�c ansierar Oate�Mo Dey,Year) Signature of 8uyerlCransferee ; Date(Mo,Day,Year)
<br /> d�W St�S�{ f�^�r:'�l' 'J. �fi� 12�a 0 X
<br /> Signature of Seller'transteror Oate(Mo,Day.Year) Signature of Buyerffransferee Date;Mo,Day,Year)
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<br /> ;� Hand-Prirrted Name(s�af Seller(si)ITransfejror(s) Daytime Telephone Number Hand-Printed Name(s)of Buyer(s ransferee(s) . ,
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<br /> � LEGAL TITLE OWNER{LIENHOIDER) 1 certlfy that the appiicant has complied wdh the requiremenls of Title 39 of the Nor1h ��
<br /> Dakota Century Code ralative to the issus�nce of a cerlificate of title for a vehicle. �:
<br /> ` Any lien recorded'm the office of the Departmeni of Transportation is shown belcw The
<br /> ;� lienholder named is and shall remain legal o�vner of the vehicle unHl the encumbrance is , ,
<br /> '-� released or salisfied, . ; ��
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<br /> � • � �, , �.
<br /> � Deputy Dir �lor foc Driver nd Veh� le 5ervices �l
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<br /> � ,. LIEN RELEASE �Y
<br /> i ALL INTERESTS IN TME VEHICLE DESCRIBEO ABOVE ARE RELEASEO. -�'
<br /> � l.ienholtle�Name +
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<br /> � Slgneture of Agent i Q3�
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<br /> � M 3 7 5 7 8 9 THE DEPARTMENT OF 7RANSPOtt7ATI�N F5 NOT RESPONSIBL�fOR ';
<br /> FALSE OR FRAUDULENT STATEMEI+lTS MAO�tN THE ASSIGN�lENT �
<br /> � OF THE CERTiFICATE O�7lTLE. �
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