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T 0 LfR ASSIG MENT ANb WA `F.T E ER T TO B Y 15 DAY TE OF S <br /> App!'icant's l,egai`NaR1a(fint.m�dle; astJ or Flrtn Name(Lessor Truet): ❑DL(] I 0 RPIDj�FFJN(C�p� Tebphone�tier <br /> MaiGngAddress CnY State Zip County � <br /> Co-Applicent's Legal Neme(first,middla,last)or Firtn Name(Lessor,Trust): DL[]CID CORPID�FEIN(�hedc c)ne} Telephone Number <br /> MaiNng Address City Zp Cow►ty <br /> Checic one: � Date of Ssie Sellfng Price <br /> ❑ ❑ And ❑ And/Joint Tenante with RigM of Survivorahip <br /> Odom��ar..Com,ete If Vehide Is less the�ten(1 D)yeare old. , <br /> 1 cert�ty 3he�er resa�rfg is�►e actual vehtcle mi�age unless one o(the foPowing statements is checked. <br /> Q Mileage atated is tn excess of its mechanical limits. � Odometer reading is not the actual mHespe yvarning*.odometer�s�x8peinoy). <br /> Name of Deekr Dealer Lkxnse Numhar S <br /> X iDrutuis of Buye�/Transferee ` Deba(Mo:,Dey,Year) <br /> X <br /> SCgnature of,4uthOfiaed/1BeM pate(Mo.�Day,Year) Signatur�e of Buyer/Tr�sferee Ddte iMo.,Dey,Ysa►) <br /> X X <br /> Hand-Printed Name of Authorfzed Agent Daytime Telephone Number Hand-Prineed Name(s)of Buyer(s�ronaferee(s) <br /> PART 2/1 SECOND 1'J�ALER ASSIGNMENT ANO.W RRAN OF Ti7LE EWER T LE TO BUYER H1N'tb DAY$ OM D T�OF 8 <br /> Applicant's Lc�a1 Nam�{A�st,middte;tast)orFrm N3me(Lessor,Trust): DL Q CIDj'CARPID FEIN t��a+9)Telephone hurt�kier <br /> Maifing Address City State Zip County <br /> Co-ApplicanYs Legal Name(first,middle,last)or Firtn Name(Lessor,Trust): 0 DL C!D- CORP(D FEIM(��o�e) Telephone Number <br /> Mai ing Address CAy e <br /> 2ip .CouMy <br /> Check one: � Or D And ❑ AndJJoint TenaMs with RIgM of Sunrivorship ������ Selling P�ce <br /> Odometer.Compiefe if vehide is less t#latt t8n(10)years pld. . <br /> i certiy the afometer"reatling is ihe actual vehicle mileage unless one of the io8owing statements is checked. <br /> ❑ Mlieage at8t�d is in_ezoess otks mechenk:al limits: Odometer reading is not the actual mileage(warning'odometer discrepancy). <br /> Neme of Dealer Dealer License Number Signature of BuyedTrensferee Dete(Mo.,Day,Year) <br /> X X <br /> Signature ofAuthorized Agent Oate(Mo.,Day,Year) Signature of BuyedTransteree Date(Mo.,Day,Yearj <br /> X X <br /> HandP�inted Name of Authprtzed Agent Daytime Telephone NumDer Hand-Prinied Name(s)of Huyertsyffarnkr�(aj <br /> PAItT 3. BllY R S /TRANBFE EE S CER71P1CATION AN�/APPUCATION PRESEt�f'i'YO OEPAft7'sA[N7 OF TRANSPORTAtION.WiT1�NqN 30 DAYS <br /> MQTOR VEH�LE EXCfSE TAX EXEMPTI�NS(F.nle�exemption numli$r,lf appUcable) � <br /> (1)Dd1 kan wite,husba�d,pntent,child,broMer,a sM..ter(Circ�cDne) <br /> (2)JdIM tman�y wNh ripM ot surnvorehfp and now reMG.^Pe is being put in one name only (14)Olsabled�Anfe+icsn Voteren or FCrt�fgr PttsO+wf�M.V}M/-Letler ai ElipiEiilyfran VA <br /> (s)lnlu:rh.+mee f��NonprnM seraort;ialiK'w mo �mpaiierJ persdna'carpraratinn,aw�ed buses <br /> (4)Cham�e of nertro M'�9e,��#ion�a courl arda tUircte Onel (te)�ioWN►Y a�ymNedps�sons Pur�sPeclatlY�equ�vehtdes <br /> (5)Vatfkle acqul�cd ilir4ugh a kase purdlase ngmemerN iCMde Arle) (191 H�rVlY(wmed partnOnhlp or cqporndon(GFrele One)DMti(Ormed <br /> A. 7(tau wss paid at1 the Io1nl 14ase c�nsrtMrNbn.�c&dw on the lease buyout amou�. (19)pifaolved paAnet9hip asotpaa5on(Circle One3 bue ds9dvetl . <br /> 8 Il laz�wu pdd on ttre fwi purchaae mm you Invn tiesn in posaesaion of lhe vehick (2�)Panod�Fa�orprNak naii-p�p(�rohilW�Uuses <br /> ovu one.yeu,tfo ta�!kdus � (2�y jr8roler inM iwqiy hwL'-.Rev�jable w krevaceble[Circ�e Onel <br /> C 1!lax wes pa�d on ff�e futi purehase price a+W y,w have been in posseseion of the vehlclo (23}Mdltsry I�omd MOctd-aMy ar d{seharye{�rcle One) <br /> for less than 91+�year.ta7�(Is tlue on�he�aa.0 6uyout arnount. (?A)Mobie Hortie($FN 90p(iaquira� <br /> (77 Lien cbange-RECORO OpOMETER READNJG (25)Nprpi Oako�pCNdcql wbtlivisbnp <br /> (B)Interslate carrlars-Aeraunl Numbar (2�Repossesabn�SFN 2880 requked) _ <br /> M1)Deoler reaale-USEO vehicle � (28)Incurance company-tatal loss seltlemeM <br /> {13)7riba1(SFN iBOBS re.qNMed)� (26)Olber 1Spec+ry� � <br /> Fu�l Purchase Price � First Lienhoider(Utle wiU be maited to fi►st lienholder) <br /> Less Trade-In Ailowance g a���ng Address <br /> Less Total Loss Allowance S <br /> Difference I Subtotal , � City State Zip <br /> Tax(b95 of Diiference/Subtotal) S <br /> Tftle Fee ($5.00) � Seccnd Lienhotde� <br /> license Fee $ <br /> Mai6ng Address <br /> License Plate CreditAmount S <br /> Plate Transfer Fee ($5.00) � City State Zip <br /> TOTAL FEES DUE: $ <br /> Year and Make of Trade-In The buyat(ap�ticanU,w,tijoot to the pe�►alttes of Isw;cetdfies the purchase prix oi the <br /> vehick. The buyer makes application for certificate oi Ntle to the veh(cle,hav'ing <br /> VIN of Trade-It1 ecquired R subject ta the liens steted. The buyer ceNffes!he vehicle is and nnli <br /> cohtinue to'be inevred while eroi' u blic alreets and h?ftw6 s: <br /> NOTE:A guide publisFwd by the automobfle industry will ba used to eh�ek vaiuis.� Signeture ofBuyeF�t'ransfeiee Date{Mo.,Day,Year) <br /> PENAL7Y:Persons making a false entry or.afterfng a govemment � <br /> document are guilty of a cless A misdemeanoc s�neturc or euye►rrra�areree oe�e�Mo.,�ay,rea�� <br /> SFN 2875(ReV.07-2011) x <br />