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CERTIFICATE OF TITLE FOR A VEHICLE

sig : KEEP IN SAFE PLACE - ANY ALTERATION OR ERASURE VOIDS THIS TITLE
THE DEPARTMENT OF MOTOR VEHICLES, COMMONWEALTH OF VIRGINIA. HEREBY CERTIFIES THAT AN APPLICATION FOR A CERTIFICATE OF TITLE HAS BEEN MADE FOR THE VEHICLE DESCRIBED i
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HEREON PURSUANT TO THE PROVISIONS OF THE MOTOR VEHICLE LAWS OF THIS COMMONWEALTH, THAT THE APPLICANT NAMED ON THE FACE HEREON HAS BEEN DULY RECORDED AS: b,-
.THE LAWFUL OWNER OF SAID VEHICLE. AND THAT. FROM THE STATEMENTS OF THE OWNER AND THE RECORDS ON FILE WITH THIS DEPARTMENT. THE HEREON DESCRIBED VEHICLE IS: I fej?
.. SUBJECT TO THE SECURITY INTEREST RECORDS ON FILE WITH THIS DEPARTMENT, AND AS DESCRIBED HEREON. IF ANY. THE MOTOR VEHICLE LAWS OF THIS COMMONWEALTH ALSO PROVIDE : te,MJ
THAT ALL TITLE AND REGISTRATION INFORMATION IN THE OFFICE OF THE DEPARTMENT OF MOTOR VEHICLES IS PRIVILEGED AND ONLY SUBJECT TO DISSEMINATION TO AUTHORIZED -
AGENCIES, BUSINESS ORGANIZATIONS OR AGENTS. GOVERNMENTAL ENTITIES AND INDIVIDUALS UNDER THE CONDITIONS SPECIFIED BY MOTOR VEHICLE CODE SECTIONS 46,2.208, 46.2-209 g
AND :46.2-210
AND 46 2-210_____________________________ ESTABLISHED 06/29/17 294 CBN06 ORIGINAL
VEHICLE IDENTIFICATION NO. YEAR MAKE VEHICLE BODY TITLE NO.

_1FTEW1E8 5HFB744 71 2017 FORD PICKUP 1505607387

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EMPTY WGT. GROSS WGT. GVWR GCWR AXLES FUEL SALES TAX PAID ODOMETER DATE ISSUED

4555 6950 6950 2 GAS 1475.78 *000100* 07/08/17

OTHER'PERT INENT~DAfA ---------- :------ ODOMETER BRAND PRIOR TITLE NO.
034524 ACTUAL
THIS IS NOT A TITLE NUMBER
CITIZENS BANK NA AS AGENT G 3 3S 5 ?25 L
900 ELM STREET NE 1545
MANCHESTER NH 03101

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INTEREST N THE ABOVE DESCRIBED VEHICLE IS HEREBY RELEASE!

By

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------TITL^ary Miles-----------
Attorney in Fact for
Citizens Bank NA Agent

Namels) and address(es) of vehicle owners:

MERCHANTS AUTOMOTIVE GROUP INC
1278 HOOKSETT RD
HOOKSETT NH 03106-1839
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gSi A Federal and State law requires that you state the mileage in connection with the transfer of ownership. Failure .to complete or providing a false statement may result in fines and/or imprisonment.
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following (printed name and address of Buyer(s))i
, Lame__________________ QO __________________________________________ s
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II I z° Street I| t” S^r City State 1"7 L

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ODOMETER READING
(No Tenths)
1 t0 lhe 13651 of mV knowledge that the odometer reading isj/SACTUAL Mileage □NOT ACTUAL Mileage
(odometer discrepancy) IN EXCESS of Mechanical Limits HMiidel year is 10 years or older and was exempt
from odometer disclosure in prior state of title .(applicant must present put-of-state title showing , exemptipn)

OCHANKAUTOMOTVEfW’
Op ctALE
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SALE PRICE—

TAYLOR LARSON - AG i '

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Signature of Seller(s) —.__ C Printed Name of Seller/s)

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Sgnaturc of Buyer(s) ................................... .Printed Name of Buyerf.s)
i am aware of the above odometer certification made by the Seller(s) '
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I ,am aware of the above odometer certification made by the Seller(s)
Dealer's No--------------------------------------------- Licensing Jurisdiction

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 Federal and State law requires that you state the mileage in connection with the transfer of ownership. Failure to complete the odometer disclosure statement or providing a S’
false statement may result in fines and/or imprisonment._____________
g B I am aware of the dealer's odometer certification. Date Date of Sale f ** I *? -^LCSale Price
of Sale
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Buyer(s) Printed Name 1/1 r * I -*-- 1 1 v-, ------------ 7/: /?
Buyer(s) Signatut
________ City
z Buyer(s) Address Zip Code
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y=cc CC S “ ODOMETER READING I certify to the best of my knowledge that the odometer reading is:
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ACTUAL Mileage NOT ACTUAL Mileage (odometer discrepancy) IN EXCESS of Mechanical Limits
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(No Tenths) Model year is 10 years or older and was exempt from odometer disclosure in prior state of title (applicant must present out-of-state title showing exemption)
^Dealerjs^^inter^aj^e ~ PLicensing Jurisdiction
a: taler certifies that the vehicle described in this^itle w^7ransferred to the abc^^iuyCr and that the odometer'feeding has been disclosed to the buyer.
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C I am aware of the dealer’s odometer certification.

Buyer(s) Printed Name

Date of Sale Sale Price
Buyer(s) Signature 5
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Buyer(s) Address___________ ____________________________________________ City State Zip Code

£8 P ODOMETER READING I certify to the best of my knowledge that the odometer reading is:
ACTUAL Mileage NOT ACTUAL Mileage (odometer discrepancy) IN EXCESS o’ Mechanical Limits
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o Q-m (No TenthIS} osura^ prior state of title (applicant must present out-of-state t tle showing exemption)
Model year is 10 years or older and was exempt from odometer disclosuij
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E Oz Dealer(s) Signature Dealer(s) Printed Name ~<<< J^Dealer Number Licensing Jurisdiction
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The dealer certifies that the vehicle described in this title was transferred to the abcfe1 le odometer reading has been disclosed to the buyer.
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s Buyer(s) Printed Name e
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Zip Code
State
ODOMETER READING
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Si I certify to the best of my knowli
ACTUAL Mileage NOT AGJUAK^I^fttj^^M^yTli^^p IN EXCESS of Mechanical Limits
(No Tenths) Model year is 10 years or oldi^hd w« ilosure in prior state of title (applicant must present out-of-state title showing exemption) §
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Dealer(s) Signature Dealer Number Licensing Jurisdiction
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The dealer certifies that the vehicle described in thi^M|^fojffiffsferr£^o the above buyer and that the odometer reading has been disclosed to the buyer.
DOES YUUWTIEHICLE QUALIFY FOR CAR TAX RELIEF? ——
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If you can answer YES to any of the following questions, your motor vehicle is considered by State Law to have a business use and does NOT qualify for Personal Property Tax Relief.

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Is more than 50% of the vehicle's annual mileage used as a business expense for federal income tax purposes OR reimbursed by an employer?
Is more than 50% of the depreciation associated with the vehicle deducted as a business expense for Federal Income Tax purposes?
• Is the cost of the vehicle expensed pursuant to Section 179 of the Internal Revenue Service Code?
IB • If the vehicle is leased by an individual, does the leasing company pay the tax without reimbursement from the individual?

£ This vehicle is for Personal Use Business Use Check one of the boxes. See business use criteria above.
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LIENOR'S NAME LIENOR CODE DATE OF LIEN
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ADDRESS CITY STATE ZIP
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VEHICLE COLOR: REGISTRATION PERIOD: 1 YR 2 YRS ($2 discount) 3 YRS (S3 discount) (Emissions areas not eligible for 3 YR registration)
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INSURANCE CERTIFICATION: A vehicle must be insured with liability coverage when it is registered, and it must remain insured while registered, whether or not it is u
ui'O operated, OR the uninsured motor vehicle fee must be paid. Penalties are severe for violation of this requirement.
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I/We certify that (check one):
This vehicle is insured by a liability policy issued through an insurance company licensed to do business in Virginia and it will remain insured while registered,
whether or not it is operated.
This vehicle is not insured; therefore, I am remitting the applicable uninsured motor vehicle fee. (This fee provides no insurance coverage.)
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LUI POWER OF ATTORNEY FOR NON-RESIDENT(S) AND CORPORATION(S) NOT DOMICILED IN VIRGINIA: Pursuant to the provisions of Virginia Code §46.2-601, tn
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l/we appoint the Commissioner of the Department of Motor Vehicles of the Commonwealth of Virginia, to be my/our true and legal agent upon whom all legal
85 processes against me/us may be served in any legal proceeding arising from the operation and/or use of any motor vehicle registered in my/our name(s) in the
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LU> oS Commonwealth of Virginia, l/we agree that any lawful process or notice to me/us which is served on the Commissioner shall have the same legal effect as if served
l-Q on me/us within the Commonwealth of Virginia._________________________________________________________________________________________
PRIVACY NOTICE: The information, including Social Security Number, is requested in accord^fcce with Virginia Code §§46.2-623 and 46.2-629. Any person who
LU O- refuses to supply the required information will be denied a certificate of title and/or registratLon'LJitle and registration records may be disseminated in accordance with
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§§46.2-208 through 46.2-214, to business, law V CK H
<</) enforcement or authorized government entities.______ pH

I- H NO PAPER TITLE - Check this box

CERTIFICATION
if you do not want a paper title issued to yon ■
Title ‘will remain on the file for this vehicle at DMV.____________________________ Z ______
Aiificate of
SALE
DMV USE ONLY WITH LIEN

YES DNO
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jc^^nstef&i^the surviving PRICE $ ___________
If this application is for joint ownership, do you wish clear rights of ownership^glpe^n^?^. CD
owner in the event of the death of either the owner or co-owner? □ YES,^^^- BEFORE TRADE IN ALLOWANCE Proof of Address m
(specify proof document presented) ZD
Are any of the vehicle owners on active military duty or service?
TAX $ ________
l/We certify and affirm under penalty of perjury that the information c< wie and correct (MINIMUM TAX MAY APPLYI
to the best of my/our knowledge. I/We understand it is unlawful to ka' mt and any viola-
tion may be prosecuted as a felony as provided in Virginia law. CLERK STAMP
SIGNATURE OF APPLICANT TITLE FEE S
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SOCIAL SECURITY NUMBER/FEIN OR CUSTOMER J| PHONE NUMBER TRANSFER FEE $
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O STREET ADDRESS
REG FEE $
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§ STATE ZIP
<o WT INCREASE
FEE $________
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£ U- EMAIL ADDRESS OF APPLICANT
cr PERSONALIZED
UJ PLATE FEE $
Q SIGNATURE OF CO-APPLICANT DATE

SOCIAL SECURITY NUMBER/FEIN OR CUSTOMER IDENTIFIER OF CO-APPLICANT UMV FEE S

PHONE NUMBER
( )
EMAIL ADDRESS OF CO-APPLICANT OTHER S

VEHICLE PRINCIPALLY GARAGED IN CITY, TOWN, COUNTY OR STATE OF

TOTAL $
CITY OR TOWN OF COUNTY OF