BILL OF SALE FOR MOTOR VEHICLE

(To Be Filled Out By Seller)

Make
________

Model

Year

______

____

Style

Color

___________

Odometer reading

Vehicle ID Number

________________

_____________________

_________

Date of Purchase
________________

Seller's Registration Number: ___________________

Have you previously filed an application for title of this vehicle? Yes ___ No ___

Seller's Name: __________________

City or Town: __________________

Address: ____________________
State: ____________

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

Buyer's Name: __________________

City or Town: ___________________

Address: ____________________
State: _____________

For the sum of _________________________________ ($___________)

I purchased this vehicle from: ___________________________

Name

_____________________________

____________________

__________

Street and Number

City or Town

State

I DECLARE UNDER PENALTY OF PERJURY THAT THE STATEMENTS HEREIN

CONTAINED ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND BELIEF.

__________________

__________________

Seller

Date