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                          BILL OF SALE FOR MOTOR VEHICLE

                          **TO BE FILLED OUT BY SELLER**

 

      Model yr.       Make        Model no./name           Body style         Color

 

      ________     _____     ______________     ___________    ______

 

 

      Odometer reading        Vehicle Ident. Number           Date of Purchase

 

      ________________   _____________________    ________________

 

      Seller's Reg. No. _______________________________   

             

Have you previously filed application for title for    ________________  this vehicle: 

  Yes___ No___

 

      Seller's Name:_____________________  Street and No.________________

 

      City or Town:______________________  State:________________________

 

     

      AS OWNER OF THIS VEHICLE, I HEREBY TRANSFER OWNERSHIP TO;

 

      Buyer's Name:______________________  Street and No. _______________

 

      City or Town:______________________  State:________________________

 

      For the Sum of $_________________

 

      I purchased this vehicle from:_____________________________________

                                                        Name

 

      ____________________  ______________________  __________

      Street and Number               City or Town                              State

 

      I DECLARE UNDER THE PENALTIES OF PERJURY THAT THE STATEMENTS HEREIN  CONTAINED ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND  BELIEF.

 

                                       __________________________________

                                       Seller

 

  SWORN TO AND SUBSCRIBED BEFORE ME THIS____day of _____19_____.

 

                                      ___________________________________

                                       Notary Public - Justice of Peace

                                      My Commission Expires: ____________

 

     THIS VEHICLE MUST BE TAKEN TO,IN STATES WHERE REQUIRED, THE

     APPROPRIATE REGISTRY OFFICE, LOCAL POLICE STATION, STATE POLICE  BARRACKS OR M.D.C. POLICE STATION FOR VEHICLE IDENTIFICATION NUMBER

INSPECTION BEFORE DELIVERY TO BUYER.