STATE OF FLORIDA
Department of Highway Safety and
NEIL KIRKMAN BLDG. Motor Vehicles
TALLAHASSEE, FLORIDA 32399-0500
PB NITER
7134823
FROM
DEPARTMENT OF
HIGHWAY SAFETY AND MOTOR VEHICLES
KIRKMAN BLDG., 2900 APALACHEE PKWY.
TALLAHASSEE, FLORIDA 32399-0500
HIGHWAY PATROL ADM. SERVICES
DRIVER LICENSES MOTOR VEHICLES Ea
FOR
TOWN OF PALM BEACH POLICE DEPT
345 AIUTH COUNTY ROAD
PALM BEACH FLORIDA 33480-4443
ATTENTION: Illp MIS
EFTA00260896
FROM : FAX NO. : Jan. 22 2003 12:31AM F'
TOWN OF PALM BEACH
POLICE DEPARTMENT
A NATIONAL AND STATE ACCREDITED LAW ENFORCEMENT AGENCY
Law Enforcement Request(s) for
Certified/Plain copies of motor vehicle/vessel records
To: DMV Representative: Date of Request: 02/20/03
DMV Photocopy Unit
Division of Motor Vehicles
Neil Kirkman Building, Room A126B, MS# 73
Tallahassee, FL 32399-0624
Office Numb
Fax Number
Contact Person:
Fax Number: Office Number.
1) Vehicle Description: UNKNOWN
Year: Make: Title:
VIN/HULL #:
FL Temporary Tag:
Name Check: DOB:
Comments: REQUEST: CERTIFIED BODY FILE ON ABOVE VEHICLES.
THANK YOU IN ADVANCE FOR YOUR EFFORTS AND TIMELY RESPONSE!
in Isms
345 South County Road • Palm Beach, Florida 334804443 • (661) 8884460 • Fax (681) 838-4700 • wym.palmboachpolice.com
EFTA00260897
State of Florida
DEPARTMENT OF
HIGHWAY SAFETY AND MOTOR VEHICLES
TALLAHASSEE, FLORIDA 32399-0500
FRED O. DICKINSON
Executive Director
October 14, 2005
CERTIFICATION
I, Carl A. Ford, Director, Division of Motor Vehicles of the State of Florida hereby
certify that I am the Custodian of Motor Vehicle Records of this Department and
that a search has been made pertaining to:
2004 DOD
VIN #
TITLE #
Attached hereto are copies of the records of the aforesaid vehicle, which are the
exact copies of the motor vehicle records as shown on file in this office. This file
consists of 11 pages.
Tallahassee, Florida
I, Carl A. Ford, Director, Division
of Motor Vehicles of the State of Florida
hereby certify that this is a true and
correct copy of the Motor Vehicle record
on this file in this office.
did,yeati
I, Carl A. Ford, Director
Division of Motor Vehicles
Dept. Of Highway Safety and
and Motor Vehicles
DIVISIONS/FLORIDA HIGHWAY PATROL • DRIVER LICENSES • MOTOR VEHICLES • ADMINISTRATIVE SERVICES
2900 Apalachec Parkway, Neil Kirkman Building, Tallahassee, Florida 323994500
http://www.hsmv.state.fLus
EFTA00260898
mTRFQ050 FLORIDA DEPARTMENT OF HIGHWAY SAFETY PAGE: 1
COUNTY/AGENCY: 68/05 MOTOR VEHICLE INQUIRY REPORT RUN DATE:10/13/2005
• RUN TIME:154748
ICLE INFO
VEHICLE ID NUM:
VEHICLE TYPE: AU WEIGHT: 4549 YEAR MAKE: 2004
ODOMETER MILES: 20 .Gvw: VEHICLE MAKE: DODG
ODOMETER STATUS: A VEHICLE USE:P BODY: PK
ODOMETER TYPE: M FUEL TYPE: G INHOUSE MAKE:
ODOMETER DATE: 10/03/2004 MAJOR COLOR:RED MINOR COLOR:
TITLE INFO
TITLE NUMBER: PENDING:NO CANCEL DATE:
ISSUE DATE: 5 CANCEL STATE: FL
SALVAGE TYPE: EFS STATUS:
TITLE STATUS: LIEN MAINTENANCE ONLY ELT STATUS: E
BRAND INFO
BRAND CODE: NO BRANDS ON FILE BRAND DATE:
0
FEID/DL NUMBER: OWNER NUMBER: 1
BIRTH DATE/SEX: RES COUNTY: 8
OWNER NAME:
OWNER ADDR:
EDGEWATER, FL
OR
FEID/DL NUMBER: OWNER NUMBER: 2
BIRTH DATE/SEX: RES COUNTY: 8
OWNER NAME:
OWNER ADDR:
EDGEWATER, FL
LEGAL OWNERSHIP:
REGISTRATION INFO
LICENSE PLATE:
PLATE CODE:
ISSUE DATE:
IR=
10/26/2004
DECAL NUMBER:
DECAL YEAR:
ISSUE DATE:
2005
10/26/2004
ARF CREDIT: 2.00 EXPIRE DATE: 10/14/2005
REG USE: PK UNIT NUM/FLEET:
CLASS CODE: 031 LOCATION CODE:
COMMENTS:
FO
FEID/DL NUMBER: REGISTRANT NUM: 1
REGIS. DOB/SEX: RES COUNTY: 8
REGISTRANT NAME:
REGISTRANT ADDR:
EDGEWATER, FL
FEID/DL NUMBER: REGISTRANT NUM: 2
REGIS. DOB/SEX: RES COUNTY: 8
REGISTRANT NAME:
REGISTRANT ADDR:
EDGEWATER, FL 1
LIEN HOLDER INFO
FEID/DL NUMBER: LIEN NUMBER: 1
LIEN DOB/SEX: RES COUNTY: 19
LIEN DATE: 03/11/2005 ELT FLAG:
LIEN HLDR NAME: KENNEDY SPACE CENTER FEDERAL CREDIT UNION
LIEN HLDR ADDR:
ORIPAIRIP.2952
EFTA00260899
WCMINIt Vl
AND, OR REGISTRATION
1 tt
TILL
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OEgI ESITTClan . DPIEES TONS NSI.Iftea fun RESCENT
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ra COX PP Lao+ isSAT N. mjc RTE.
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o —1 0 () I0 l() j () . (W, 1.. 2 1 O. (x) 21...7 . IX. 0 - (X) I 28 . 2 ;1
I ..:11:::N IYIASINITEFIAINI(..E
A, NINON Nara
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)/AnOAC
SLA:lX
°10/ MnN
ZX 20 MILES 1.(1/03/2(X)4 nurt.w-N...
DATE a LIES DID • Oaf a • AND SEE AND DATE OF BIRTH
LIEN INFORMATION ODOMETER
EL:r 03/11./2.005 DECLARATION
WI( a FIRST liENHOLDER OF NO LIEN, ENTER AOSEI CERTIFICATION
KENNEDY SPACE. CX-EINITETZ FEDERAL CREI):T
VEIIICIE USE
OTY TATE LIP CODE BAWD/A I E
SEL nea..A141), I•• I... 6'45'112
NAM Of M LIM FLORIDA DEALER. OR OTHER PRIMUS OMAR
ADDRESS
CITY STATE ZIP CODE
DEN ER IKE Nat NO
SALES TAX AND USE REPORT CONSUMERCR SALES TAX EXEMPTION a
TRANSFER OF TITLE
IS EXEMPT FROM PURCHASER HOLDS VALID
FLORIDA SALES OR NDCATE TOTAL PURCHASE PRICE, !WILDING ANY
❑ EXEMPTION CERTIFICATE UNPAID BALANCE CUE SELLER, BANK OR OTHERS S
USE TM FOR THE
REASON(SI CHECKED O. (x)
VEHICLENESSEL WILL BE USED
O EXCLUSIVELY FOR RENTAL
iNDOCATE SALES OR USE TAX DUE AS PROVIDED 8'
CHAPTER 212, FLORIDA STATUTES S
0.00
1 OTHER SLUNG PRICE VERIFIED
APPLICANT CERTIFICATION
0 LOVE HEREBY CERTIFY TITAT THE VEHICLE/VESSEL TO BE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HICHWAYSMATERWAYS OF THIS STATE.
0 I CERTIFY THAT THE CERTIFICATE Of TITLE IS LOST OR DESTROYED.
0 I CERTIFY THAT Tills MOTOR VEHICLENESSEL WAS REPOSSESSED UPON DEFAULT OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION,
LWE HEREBY CERTIFY THAT LAVE LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL AND MIME APPLICATION FOR TIRE IF LIEN IS BEING RECORDED,
NOTICE IS HEREBY GNEN THAT THERE IS AN EXISTING WRITTEN LIEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY
LIENHOLDER SHOWN ABOVE. IWE FURTHER AGREE TO DEFEND THE TITLE AGAINST AU. CLAIMS
UNDER PENALTIES OF PERJURY. I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Signature of AppacantrOwne• Sgnature of Applicantto-O.ner
ince 82O4lottv.O1O2, 5 DMV COPY
EFTA00260900
LE
2s .. t.nn rat S, .7.1 •.o O.F MOTOR VEHC
R SECINCIN 119 23/a
BEEN StRIVITTFO thNOC .3 —At '''°
F OF OWNERSHIP HAVING AWED “EREIN :,- "°
SAnTFACIORY PROO Is vaI£D .
4.114 k oyts tals1
OR VESSEL oEsOro .O. BELOW ,-'" FOR SAO MOTOR vEINCI.F. OR VESSU
' 1 -.
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2004 00CG
f .00E,
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PK
, '
4543
— NO OF f3FUVIOS
(RED
PRIMARY BRAND
VLS-FACTURLR UR OM USEUAL
I
SECONDARY BRAND ..
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10/20/2004
j.
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t 5
RIBED
AILEFS! IL. OAF ASOF,F, DESC
AMICREDITFINANCIALSERVICES,INC7
Is I !. LLAC:
10/03/2004
FIN ANC IAL SERVICES
AMERICREDIT
PO BOX 182673
ARLINGTON TX 76096
FLORIDA DEPAR1.
.....4. k":..,.. VEDIC I S
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EFTA00260902
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
Neil Kirkman Building - Tallahassee. FL 32399-0610
APPLICATION FOR NOTICE OF LIEN / REASSIGNMENT OF LIEN OR
NOTICE TO FIRST LIENHOLDER OF SUBSEQUENT LIEN
SECTIONS 1 AND 2 SHOULD BE COMPLETED IF ADDING AN ORIGINAL LIEN. O MOTOR VEHICLE
SECTIONS 1 AND 3 SHOULD BE COMPLETED IF REASSIGNING A LIEN. O MOBILE HOME
SECTIONS 1,2 AND 4 SHOULD BE COMPLETED IF ADDING A SUBSEQUENT LIEN. O VESSEL
- 4rirrremmmir
iailDRYEHICLE. MOBILE HOME %VENAL_
sE
DESCRIPTION
'ORATION NUMBER
MAKEIMANUFACTURER YEAR MODEL WT.-LGTH.-BHP
DODGE 2004 RAM 1500
COLOR TYPE USE
CERTIFICATE OF Ti l LE NUMBER PREVIOUS ISSUE DATE LICENSE PLATE NUMBER
2 NOTICE OF LIEN - Lienholder information
DATE OF LIEN FEIDO/SUFFIX# OR DL# OR SEX AND DATE OF BIRTH L ENHOLDER NAME
11MAR2005 Kennedy Space Center FCU
LIENHOLDER ADDRESS CITY SiATE ZIP
Merritt Island Fl 32952
D Electronic title and lien participant (Eledronic title only).
[1] If the lienholder authorizes the department to send title to the owner, Signature of Lenholder's Representatwe
check box and countersign. (DOES NOT APPLY TO VESSELS)
One of the following boxes must be checked.
LI A security agreement, retain title contract, conditional bill of sale. chattel mortgage or other similar instrument was
ut pool to the filing of this notice of lien.
execed
fj This notice of hen is being filed before a security agreement, retain title contract, conditional bill of sale, chattel mortgage or
other similar instrument is being executed.
UNDER PENALTIES OF PURJURY, I DECLARE THAT I HAVE THE FOREGOING Date 11MAR2005
DOC---- ATED INIT ARE TR
Street Address (Owner) Street Address (Co-Owner)
EDGEWATER FL 32141 EDGEWATER FL 32141
City State Zip Code City State Zip Code
3 APPLICATION FOR REASSIGNMENT OF LIEN
The undersigned herby represents that they are the assignee of that certain 0 first or 0 second lien dated the day
of (Month/Year) . covering the motir vehicle, mobile home or vessel described in section one of this form and
request that the Florida Certificate of Title, which was issued on (MonthDay/Year) , be
reOissued to show such lien as now being held by the undersigned applicant and represents that on this date there is a balance
as principal still due and unpaid.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Name of Assignee (New Lienholder) By Signature of Lenholders Representative
Title
Address City State Zip
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
By
Name of Assignor (Lienholder currently shown on Trtfe) Signature of Lienhokler's Representative
Title
HSMV 82139 (Rev. 03/02) S hnfrithintew.hsmv state.flus
EFTA00260903
STATE OF FLORIDA
APPUCATION FOR VEHICIEWSIt
CERTIFICATE Of TM
F
8 70 CVR 0 a TI
101
RP- 0
BIRINDATE ExPRES Tugs NsuBw:E OJT( RESIDENT car DATE CF ISSLE RA mj ER ca Roma,
r CODE IV uktt,TY SIM an urn FESS IC DAY ?DP
TIT NUWEER 113 LUXE
Ar EP
IIAKE a IMAUFKTURER BOOT WPE
e --111-44
CLASS WT /LENGTH ...„
.
9 nol 11003
WATER co,!
31
ANI(XE COLCR
L4549-I INC/AEA R. ' CPU CR FEIDA
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2N
Axicen / Ones Nam &Kerns
. EDGEWATER, FL 32141 •
•
CREDIT VE0.10.E
F El AULEER WPLENGTH LOS REG FEE NT REG AGENCY FEE MM. FEE TITLE FEE SALES TAX MVO TQTAL
I 19 53.10 !MI 6_75 0 00 3.88 85
Acta. Regaftel ORIG NEW TITLE Etwre:
STATE PRO. KM ( VII ACQUIRED Wm LEO 000MERR r VESSEL MANO,VII ...ik
10/03/2001 30C 20 MILES 10/03/2001 ACTUAL
DATE Of LIEN HID I OR ELI EFL I AND SEX AND DATE OE Mill
LIEN INFORMATION ODOMETER
DECLARATION
10/03/2004 CERTIFICATION
NAVE OF FIRST LIENI4OlDtR' !If NO LIEN, INTER NONE.
ANERICItEDIT FINANCIAL SERVICES
AONESS VEHICLE USE
PO BOX 182673 PRIVATE
On' SLATE DP CODE SALVAGE TYPE
Annitarati. TX 76056
SELLER INFORMATION
NAVE OF SELLER. it ORJOA DEALER, OR OMER PREVIOUS OWNER:
DAY2'0NA DODGE
ADCRI SS
1150 N POMONA EAR/48 RD
Oh' STATE ZIP CODE
DAYTONA BEACH, FL 32121
DIALER LI( E Nsi r‘k,,
VF011189
SALES TAX AND USE REPORT CONSUMER OR SALESTAXMB:TONI
TRANSFER OF TITLE
IS EXEMPT FROM ❑ PURCHASER HOLDS VALID INDICATE TOTAL PURCHASE PRICE, INCLUDING ANY
FLORIDA SALES OR EXEMPTION CERTIFICATE UNPAID BALANCE DUE SELLER, BANK OR OTHERS S 0.00
USE TAX FOR THE
REASON(S) CHECKED VEHICLENESSEL WILL BE USED INDICATE SALES OR USE TM DUE AS PROVIDED BY '
❑ EXCLUSIVELY FOR RENTAL CHAPTER 212, FLORIDA STATUTES s
0.00
❑ OTHER ill SELLNG PRICE VERIFIED
.
APPLICANT CERTIFICATION
i IME HEREBY CERTIFY THAT THE VEHICLE/VESSEL TO BE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HIGHWAYSAVATERWAYS OF THIS STATE.
I I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED.
El I CERTIFY THAT THIS MOTOR VEHICLENESSEL WAS REPOSSESSED UPON DEFAULT OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.
NNE HEREBY CERTIFY THAT VINE LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL. AND MAKE APPLICATION FOR TITLE. IF LIEN IS BEING RECORDED,
NOTICE IS HEREBY GIVEN THAT THERE IS AN EXISTING WRITTEN LIEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY
LIENHOLDER SHOWN ABOVE. I/WE FURTHER AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Signature of Appticant/Oerner Signature of Applcant/Co-Ottner
Hmtv 82011 (REV. 07.02I 5 DMV COPY
EFTA00260904
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
Neil Kirkman Building - Tallahassee. 32399-0500
MOTOR VEHICLE DEALER TITLE REASSIGNMENT SUPPLEMENT
(Instructions on Reverse Side)
For use by licensed MOTOR VEHICLE DEALERS. AUCTION DEALERS and THEIR BUYERS ONLY
Fl.
I his reassignment is supplement to: L_J Title No.: State of Issue-
XX
0 Manufacturers Certificate of Origin
VEHICLE DESCRIPTION
lillall. Year Make Model Body
2004 DODGE TRUCK RAM 1500 1500
REASSIGNMENT INFORMATION
, Name of Soilmg Dealer (PrIng Dealer License Number State of License
DAYTONA DODGE V? 11489
Street Address City State Zip Code
1450 TOMOKA FARMS ROAD DAYTONA BEACH FL 32124
Sales Tax Collected Sales Tax Reg. No. (Sales Tax Information is not required on dealer to dealer transact.ons
$ 1684.54 FL
Billi Date of Sale
10/03/04
B rs Address City State Zip Code
EDGEWATER FL 32141
Auction Name (If applicable) Auction License Number State of License Date of Auction
N/A N/A N/A 10/03/04 •
Street Address City State Zip Code
••
N/A N/A N/A N/A
ODOMETER DISCLOSURE STATEMENT
WARNING: FEDERAL AND STATE LAW REQUIRE THAT YOU STATE THE ODOMETER MILEAGE IN CONNECTION WITH TRANSFER
OF OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.
I STATE THAT THIS WTOE VEHICLES 0 5 DIGIT OR 0
6 DIGIT ODOMETER NOW READS RIPAFF
XF (NO TENTHS)
MILES, DATE READ 1 "/ " 3 / " AND TO THE BEST OF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE
VEHICLE DESCRIBED IN THIS DOCUMENT, IINI FRS ONF OF THE FOI I OMEGAS CHECKED
CAUTION:
NOTCHECx
00IFYILEAGE DI
I HEREBY CERTIFY THAT. TO THE BEST OF MY KNOWLEDGE. THE ODOMETER READING REFLECTS THE
AMOUNT OF MILEAGE INEXCESS OF ITS MECHANICAL LIMITS
lACTUAL 02
I HEREBY CERTIFY THAT THE ODOMETER READING IS_NOT THE ACTUAL MILEAGE.
WARNING • ODOMETER DISCREPANCY
SELLER AFFIRMS. UNDER PENALTY OF PERJURY. THAT THE ABOVE
FACTS ARE TRUE AND CORRECT TO THE BEST OF lq/MFR nirmul crinF
Dealer S Agent Printed Name (Sellin De
DAY
e
Last
City State Zip Code
EDGEWATER FL 32141
NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS RE-ASSIGNMENT AND ALL RE-ASSIGNMENTS THAT FOLLOW.
FILE: • ORIGINAL: WITH TITLE OR MANUFACTURERS CERTIFICATE OF ORIGIN COPY: DEALER RECORD
HSMV 82994 (REV. 01/03) S
EFTA00260905
• 1451 r
DAIMLERCHRYSLER
DaimlerChrysler Motors Company LLC
INVOICE NO
DATE
4DR1
07-07-04
YEAR MAKE
, E NTIFICATION NO
2004 DODGE
SN,
BODY TYPE
4549
1500 REG. CAB PICKUP
OVWR NO. CYLS &ER ES OR MODEL
ri A S A E 1
1/2 TON 6350# 8 RAM DR1H61
49.1
below, hereby cer-
of the company, firm or corporation named
I the undersigned authorized representative the propert y of the said compan y. firm or corporation and is
tify that the new vehicle described above is or dealer.
Number indicated to the following distributor
transferred on the above date and under the Invoice
NAVE Or DISTRIBUTOR DEALER ETC
DEALER NUMBER 42243/42243
DAYTONA DODGE CHRYSLER
1450 NORTH TOMOKA FARMS ROAD
DAYTONA BEACH FL 32114
commerce.
r of such new vehicle in ordinary trade and
It is further certified that this was the first transfe
MAIL TO:
DAYTONA DODGE CHRYSLER DAIMLERCHRYSLER MOTORS COMPANY LLC
1450 NORTH TOMOKA FARMS ROAD
DAYTONA BEACH FL 32114
SCNATD AUTHORIZED REPRESENTAT i.
AUBURN HILLS MICHIGAN
13425016 CITY STATE
'CERTIFIED FOR SALE IN ALL 50 STATES'
EFTA00260906
9
Each tcdngnn tear coal*, to Ee pm of nit traModge
. intonnation an, bele* under penalty 0
Met any stale le the lire apt be that no Fantle h ,es con's tha n teen von:bone] In
and iv verb} is rat Sublea to &quetzal
Interests otter tan ebb cleckeedli.ner And wintry
tie Un the VONtie•
FOR YALUF rEIYFD I TPAUSFER TTIF VEHICLE DESCRIBE
NAME OF D CN THE FACE OF ILES CERTIEICATEJS
- FLARCIIASERS)
, e
8g ADDRESS
C 3 I portly to the test of My acerrap
!he: to odometer read a; a
th Z
No Tenth,
2 `r
D Isr
DEALER ;
',Ara Or :Maar' tter Fn 5 LICect sr. Be
26 Stela o'
•
•
Barb sly mom upon okn soya bathe tatterterth
ban are iew are correct. Subeated and morn
to me
.
•
2 Countr. Ce helm the dap 0,
- - 20—
USE NOTAPIZATOTI NM T IF RECAAREO Notary P.otriC
NAME OF Fo talluP JORaDtpLet
•
KIRCHASERIS,
i
ADDRESS
1 oath. b be Mel O. my Uneven's
i DISTRIBUTOR DEALER
Tat the odometer baling 's
No Tenn:
DEALER ,..,„
„ oi,„„„t BY
Petro ely mom uncut PT says net the statornofes se
ASS/GWENT NUMBER 2
Stu* of_
tort) are true and Abaci Submit*, and morn to ma
County of babe the fay ot--
is ROTAFIAZA:ON de-Y .c Rf Web) II4 T•Tt Fe: Weary PUDIC
NAME Or beeDICPPT
I DISTReBUFOR:DEALER
PliFICHASEP,SI
ADDRESS
I conlsm lo too pat on my knoWoo94
env. the cePive* resting 'S
No Tenths
DEALER
mur OF OFFEibma, BY
ASSIGNMENT NUMBER 3
&PUTS Tante uniniSA
Relay Only mom upon oaT rap !hot the ettlemorts
iura a 1 sat
UM are the 500 correct. Sub.:rood and amen
to me
Cony 0 Mtn, nut Osy of 20--
I.M NOTAbyett,ryy cee y a ws s e Homy PuMt
NAME OF piirTit U N
DISTRIBUTOR-DEALER
PLItiremsEIFSI
ADDRESS
I tenni to We beta 0 rry Itnem*121
Wt one oteraMer rehanS •
; no Terros
DEALER
ASSIGNMENT NUMBER 4
Few ce CE.Neldrim CE.Farilt655€ rourAW BY
U
Best) dual firrum upon on, says stye ow statements set
Sram 1 I loth aro InD and caw!. Spouted and seam
to me
Casey of i Rub., ma clay c4 70
Linn 41TART7A1014 'PAY M IV Qin 4 I(Nem luoiSNCTai Notary NON
Federal raw rOrtare3 sue 10 state VI olmneate
/alarm a cOnnecton tom se nonage a obbetsp,
muss Ines arctic", anpersonmnei Faro *complete or Vereuin a
*se slecnom may
ODOMETER DISCLOSURE
I picky 10 the cost ol my itramitap
Fuwing i that the odanelet reeding is the
i tam trumpeters vent* trans one of li e Vimeno
NO Tenths. El The mastic staled is m
erten a en nuroChaniCal 'Mita 0 The cdemetm
gasoinents is °Socked Ociarninee
rtadao a net re actual Wean°
S vet/urea) 0, Setoffs)
WARMNG ODOMETER DISCREPANCY
Prntop Namels) of Sollp(s).._ Da} of Statement Dato ce Sale
! Ombra No
Bono clury SWOT UPOn Cell WO Tar the statemonts sot
FOR RETAIL SALE
Signalufe of Pischtlerts) to are fruo and 'erect Sulunnter0 and Morn to me
behx, y.,3
PonIed Nano Cf PuscNnerls) Om a 20
1
Wiley Punic
COMpany N.,T1 (I An:1<We' __i
Stale ce
Address ci Purchttwal c„,,,,. cu
I
UV NOTARIZATarLy Lt RI GUIRFC
I isi eltlINC; rUeruSOICIICG
Cr isf .en 41Ianx of
t mvddi irldrees a _.
Fro .en in Pee 0 ,e
anon atIckess is 4
EFTA00260907
I0
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES • DIVISION OF MOTOR VEHICLES
NEIL KIRWAN BUILDING • TALLAHASSEE. FL 32399.0610
APPLICATION FOR CERTIFICATE OF TITLE WITHAVITHOUT REGISTRATION
ALSICATiON TYPE' n X0RIGINAL O TRANSFER VEHICLE TYPE' O OFF-HIGHWAY VEHICLE &MOTOR VEHICLE El MOBiLE NOME O VESSEL
OWNER / APPLICANT INFORMATION
Cabinet Number Und Number Rem We
ffPOR O MC NOTE: Veil Oil ormerstip.FIesse coca il'a' Wardle lobs sew on r le stn issued If nether box is el clad, the Me will be IssuedMTV'S".
Outs Firs' Nano Full MidderMsiden Nang. Last Name Date ' FL Omer License or FESOISurnx Merest
. Last Wm* Daum inn Sex FL Crher License or FEIGISulex Humber
Lenses Fins Hamm RA laddlealaicien Name. Lest NsMe Oat of OEM Sec FL Other Manse or FECUSufix Number
Gly sins Zip
a
EDGEWATER FL 32141
os.......ii fi i r alogy) GU Sate Go
EDGEWATER FL 32141
Owner: or Lessee's P 'Ul Street Address in ROW alandmoryl Cry Stsle Zip
EDGEWATER FL 32141
City Stele Tap
Physical Address of Mabee. Noma Of sopinable) Chub if motile Mane is impart sab IR or num Iste O
Mel To Cutlery* Name (II different From Above Dense) Date olefin?, Sex FL Delver License a FEID/Suera amber
Mal To Customer Address (If different From Wore Wane Meets) City SUM Zip
12attriti 1, 7 2. 7 • ii: ',: . —7 . - .- I MOTOR VEIN LE Bodi • : ' . • ' yriRe4.-A. ...• ; .,41,
saL, DESCRIPTION
actIdOrME OR VE SyE
maIkMOBILr nue
..” •ym ........A,,...,J.
VsNcllIllnim IAerbr
'
DODGE TRUCK 2004 1500 DP MO
M 493
Piraeus Slate of Issue Lame etItesestReDstam NAME Weight ARUM BlIFECC GEWA.00 Florida Omani Dale of Issue
R.
(
M.
V,PLU TYPE
eU) 49 (-
1
NULL MATERIAL PROPULSION FUEL 'DRAFT OF VESSEL
0 OPUS Motets* 0 Musette' 0 Pelona' Wang 0 Wood 0 Abrams, 0 Ceitcard 0 Sal a Gas (The *AM et Sera
• Cabin Molodnel 0 Pontoon 0 Canoe 0 FillergU6S 0 Sleet 0 Inboard 0 AV PrOpend 0 Mese Vessel dam)
ill AaTrafy S3ROM 0 Memel 0 CAW 0 x1/40aftervass 0 Inboted/Getrefd 0 Nett
FT. IN.
0 IRMO) 0 &Meow see* Dote El Dm( 0 COM 'Axel vends Menem le
SP* Speay SPOOY Asserene se mama
USE OF VESSEL QMLIC Ce•Oomer PREECUS
0 Reaeatoral (Plume) 0 Commercial Eta Crab 0 COmMercile SEM OW WE-OF-STATE
0 Deane/Marti 0 Commercial Fen M Corn/nen:HI We Bat 0 Commercial Steiso Retie. Are )wa Ronda rwderf? Oyes Ow Oyes Eno REGISTRATIONNUMBER
0 Exempl 0 Kre fr try) 0 Commeloal Madras' 0 Commercial Strew hionaeop. Are )CO an alto? Oyes OnCti Ores DIM
0 Government 0 Commercial Sponge 0 Commei°al 0A* 0 commeroliscineyutder
0 Commercial Dialer 0 Commecia Over
Patti* Ferierldy Datartented Venal.Mach Copy ot Staled Principal Use
a U.S. Coast Guad Relax From DecumeMellon Faux or • Cop/enameled Docunenumn Papers
3 4 •••;•4.4•••. , 4.. • BRANDS. USAGE AND TYPE 'Knock Applicable Boxes)
• &CRITERIA LEASE O LONG TERM LEASE • RESULT ['PUKE VERCLE diEtNATE USE • TAXI CAB OFLOCO VEHICLE • LEV VEHICLE
• ASSEMBLED FROM PARTS O REPLICA • MT CAR O GLIDER KIT O MANUFACTURER'S WY BACK - • ELECTRIC VEHICLE
4.ttlaret 1>teekt ,•• .# , .. ., • , . .. LLENHOLDER INF RMAT1ON ' - —
CHECK* FEID ea DL 5 end Sex end Dale *GM Dale of Lien Lilmherdes Harm
ELT CUSTOMER NI 10/03/04 AMERICREDIT FINANCIAL SVCS INC
LlenheldeesAddrees City Stale VP
PO BOX 182673 ARLINGTON TX 76096-2673
n MUNI** attain the Department* Nod te mar vetkle cr motile Mae tile to the otter, duck box and swims:in
' (Does MI mply lovesselspl bp( is col eltecketIlle WI be milled m i.e Orsl leaned* (Sgnalure elLleNtIders ReeresemLslite)
5 I . - •--- , TRANSFER lYPE
F OWNERSHIP KW TRANSFERRED.KW *HOMIER WAS RE WDOCLE.TIOINE NINE. OR NESSE( ACCORD)?
CYXLE 0 GET 0 REPOSSESSION COURT ORDER 0 OTHER (spasm _ WOE ACQUIRED .I0 03, 04
6 ) ODOMETER DECLARATION
WARNING: Feder* and 5131*lnrequires that you stale ***Nage In connedim with an asalludlon For *CAMEO, of TAM Falun lo compete Of prarlang a It. statement may atoll In Met cc Imonsonment.
I STATE THAT NIS MOTCM VEHICLE'S O S DIGIT OR ❑ XDISIT ODOMETERNON READS =ODD Er eo Toms) PALES DATE READ bai_93 /9Ao TO THE BEST
OF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL AILLELDE OF THE VEHICLE CESCRIBE0 IN T145 DOCUMENT UNLESS ONE OF_THE FOLLOWING IS CHECNED
cAunott O i.I HEREBY CERISE THAT. TO MERESTOF MY MOMEOGE, ME ODOMETER KAMMREFLECTS IsEAMUNTCE IMAM lj gatssETTEACREALEGELas
=fa CHECK
9 ACTUAL NUM O 2. IHEREBT CERMET MAT THE 00CeETER ADDEO § NOT TIE ACTUAL ritclata WARMING 000METER DISCREPANCY
7 I DEALER SAL S TA% REPORT
FLORIDA SALES TAX REGISTRAPON NUMBER DATE OF SALE DEALER MEESE NUMBER AMOUNT OF TAX
74-8012066825-9 10/03/04 VF11489 1684.54
HEW 82040 (NEV. TOMAS h lialMyriehsmv.s Tataus
EFTA00260908
MOTOR VEHICLE IDENGFICARON NUMBER VERIFICATION
THIS SECTION REOWRES A PHYSICAL INSPECTION AND A VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER 320
(OP THENOTORRUMBER FOR MOTOR WHICLEIALASLUFACTURFQ
PRIOR TO WS) OF THE MOTOR vEiocAE DEscamED On THIS FORM BY A LICENSED DEALER. FLORIDA NOTARY PUBLIC. POLICE OFFICER. OR FLORIDA DIVISION OF MOTOR VEHICLES
EMPLOYEE OR TAX COLLECTOR EMPLOYEE. IF THE Vim IS VERIFIED By AN OUT OF STATE MQT.Q&Y.LbTALPKAL IA T I RH
STATIONERY COMPLETE THIS SECTION ON ALL USED MOTOR VEHICLES. INONOwG TRAILERS. (vall. ABBREVIATION Of TV WITH A WEIGHT OF 2.000 POUNDS OR MORE) NOT CURRENTLY
TITLED IN FLORIDA
1Se uGIll'OneGcetlEY NMI Ave Playearr InsPreled LEN abrve deserted wade and red re where identnouns number Io be
was tame...rum Renton
DATE SIGNATURE PRINTED NAME
the Enforcement Olen ct Fkr.S. Oates Name Badge e or F1cda Deaet Hatay Sorry cr Seal
FL DMWTax Coleckx Emothee Florida Orrakirce ExurtnerAnsseclx Badge a ID iamb,.
FASIONISENWED NUN Of FICRDA KIRKE WARTS SKNATURE
EBeramtnecal
SALES TAX EXEMPTION CERTIFICATION I
THE FURODSE OFAREEMATIOWL UNCLE TO eL OFFERED FOR RENT ASLIIWG ACCOMINDATKINS DOES NOT QW&PY FOR ENDMI1Cer. ICERNYDE RECREATE/Nit VEHICLE MALE NOME OR VESSEL DESCRMED WS NEN
rlgtOt WAND IS KOMIFROM TIE SALES TM ROMEO EY (RAFTER 2i1. ROAD/. STATUTES, or
L.
CalSuirERSCERTSKA E OF ExErATKer KAMER
❑ PURCHASER (STATE AGENCNS. COWRIES ETDINOLDS VALID EXEMPTION GEWGAW
❑ HOTOA VERNA O "MAE HOME O vESSaHu PE USED CaCLUSMLY FOR RENTAL
SALES TAX REGISTRATION/MUSES
I heresy sentry that ownership of the motor vehlde, made home or vessel described on lit applcaten, is not subject to Florida Sales and Use Tax fa the folioning reason: ONBEETANCE O GET
O DIVORCE OECREE O TRANSFER BETWEEN HUSBANO AND WIFE O EVEN TRADE OR TRADE DaAN (State ha Mots of the even trade or trade down and the transferor Information, Including
the transieroes name and address, below ender 'Other: Explain?)
Oommt(ExPuw)
Ttelk REPOSSESSION DECLARATION •
IF CHECKED, ME FOLLOWING CIFMFICAMONS ARE MADE BY THE APPLICANT:
O I CERTIFY MAT THIS MOTOR VEHICLE, HOKE HONE CR VESSEL WAS REPOSSESSED UPON DEFAULT IN THE TERMS OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION
(VESSEL) A PHOTOCOPY OFT* UENINSTRUMENT FOR THE VESSEL IS REQUIRED AND /MAORI).
11'o .-.. no: NON-USE AND OTHER CERTIFICATIONS,
F CHECKED, THE FOLLOWING CERTIFICATIONS ARE MADE BYTE APPLICANT:
❑ I CERTIFY DLO ME CERTIFICATE CF 1711E IS LOST CR DESTROYED.
❑ THE VEHICLE IDENTIFIED WILL NOT BE OPERATED al THE STREETS MO HIGHWAYS OF THIS STATE.
❑ THE VESSEL CF-NTIFIED WILL NOT BE CPERATED ON THE WATERS OF THISSTATE.
O OTHER (MINI
' APPLICATION ATIESTJENT
SIVE PHYSICALLYINSPECTED THE CODMETERANO NNE FUR1l E TO DEFEM) THE TYRE AGANST ALL gr.atures.)
UN REDOING DOCUMENT
The undersigned person(s), stale as Mows: Thal County. Florida died on the day of
20 0 testate (with a will) 0 Intestate (without a will) and left Sun/rung (hinther) the fOTOvang beneficiaries:
SIgnaturels) of surviving spouse, co.owner and/or heirs. (More than one form HSMV 82040 may be used for additional ugnatures.)
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Print cc Type Name of Spouse. Coowner or Heels) Signature of Spouse. CDOwnAr or Holds)
That al he Arne of dear he decedent was coma of foe motet vends, mobre home or vessel den-Abedin recto 2 of hs teen That the estate is nor orleb!of ad the assets dew rude, tutting pis mei woe.
stable Mae of vessel we surineN to pay all jceldaD4 and that no probate poceedngs hate becalm/00W won We atilt. That to pywn(s)OO1rig abase hereby releases all Var n94. Mt.:Taal and dames hers
a! Mw, Ivrea, Outlet. or utenuse lo the Wand meet what, retie Inure or vessel lo:
Marne of Applicant(s) (Print or Type)
RESIDENTS OF FLORIDA AND ALL VESSEL OWNERS, RESIDING VI FLORIDA OR OUT OF STATE, SHOULD SUBMIT THIS FORM MD ALL REQUIRED DOCUMENTATION TO A LOCAL FLORIDA TAX
COLLECTOR'S OFFICE OR THE FLORIDA TAX COLLECTOR'S OFFICE LOCATED IN THE APPLICANT'S COUNTY OF RESIDENCE FOR PROCESSING.
HMV 52140 (REV.10030) 5 hnptitenvw.hsmrstaltiles
EFTA00260909