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cnn�vfe acva_ suQ! R�T� I ��I �� # � 1066588 '� I S � 2I 5319 ��li�� m 987174583 -. I. ._. I_._.___.. STATE OF�LOR�,I� e6 �sa9sq �auoiT�l • • � S8A17824 ; A.PPLICATION FpR Y�HICLE/VESSEL ; , • ---.....__.... I CERTI�'1CATE Ok"�'�LE �• ...- . . .._.........__..------. _...._..._._ ... . TITLE NUMBER VEHICLElVE53EL IDENTIFiCATION* 1fR,MA}(C MAKE or BODY y�ryICLE COL6R 4YTILENG7'H GVW(LOC � MANUFACTURER TfPE ---• .._..._ i . .. __ .. .. ,__ i �----• ....__ . .-- iI 21396443 I K8225PJ3....._.,...._.._ ._. � ]982 i f SEAB . .... I r•TS �UN.K _ � �7�-----.--.....,I I__� , nATE OF ISSUE TRWre3 �H t C I.E U S E N�� P R O P U l,5�4 N F U E I V E 8 8 E L WA TER F�NUMBER A U T F f � MQ. DAY YEAR COdE M/{7�� 7ypE DESTRUC7101+1 I . . ..-- -- .. ._..____...- - - . . '•. 09 ;29 I 17 � ��fi_ i -pR��.�8....� . . .. _..._le��---.f _: �: �� I _...._.....�-.---_l_-..--.--- �-------..-. �--.--... � BIR7WDA7E RESIDENT CNTY ' S�X MO, DAY YEAR Y N ALIEN REs� ADP�IcenUOwnAra Neme&Addroae , � ro sax�s�Lr_c i� -��-�-�--� ��_.�__._I... ! I Z8._� � ZE�HXRT�IL�.S,FL 33534-0753 iat OWNER FUD�OR zna owni��roua oR ; F.E.I.D.� uNn� , ... ......... ... . . . .. ' 814850323-01 I I � j VOLUNTARY GONTRIBUT10N5 . .... .... ....... ..._ .._.. ............. .__..._. .. . ........ .. ! AGENCY nn,E FEE 9ALE8 TAX GRANb TOTP1� � FEE � � . _...__.._... ._. , ' � 4.25 73.50 � 0.00 77 75 I � --. .._._ , ._........._---.--------_..._ . _. . .. _.... . ---. �---.—J �---_--.----I �...._._..._ .. ; . � , Aet�on Raqaeatefl: TiZANSFERTITLC Brande: � I . . .. . ..._._.T............. . ... ...---�-��-�-�--•—�--�--•----._..__...... .__.._.. ._._._..-----.._._..---._.J PREv STATE. DATEACQUIRED 'NEW USE9 ODOMEiERlVES&ELMANUfAC7UftEt2 OPOMETER I � DECLAkATION I � CER'fIFIGAT70N i �z, os�i4aoi� xx � . �_..._...._._... ---.... . .. ...---=---- ----�---._.... .. . ............._ -�-�------- ----_.__---! II •LILN INFQRMATION DAT�OF LIEN �CEiVED Dn7e FEID C OR FLJ DLdINQ SD�AND DA�OF B�RTH DMV ACC�)UNTl� NAME OF FIRST LI�NHOLD�R; ; _ .... I �AODRESS SALWAOETYPE i I , . ... �._...--• ----------._._.._...._... .. ... . ......._._..-•--...-•-•-•--• -•--------•--••---•-•--........_._.__....._. 'S��LBR IIYFORMATION NAME OF SECLER,FLOliIDA DEALER,OR OTHER PR�VIpUS QWNER ' AODRESS I , I ;DERLER LICEN9E NO. ---- ------._.._.—_.�.---.... _. . . � •CONSUMER OR BALES TAX E%EMPTiON 9� �.. ._._.... .. . • • -� ---•---�..—.-- ---•-- -----------•—•—••------.._....._ ....._....• _-•-• •_ I SALES TAX AND US.E REPORT INDICA7ETCRAIPURCHASE PRICE,INCLUOINGANY & � UNPAItl BAtANCE OUE SELLER,BANIt OR 07HER9 I TRAIQ3F&R OF TITL� ❑ L��'RC�ISER FTOLD$ VALID •----•. ...__.__.._...._ I3 EREMPT FROM EREMPTI82Q CERTIFZCATE INDICATE$ALES ORUSETAI(DUE/AS PROVIDED e1 CNAPTER S O.00 FLORIDA SAL�S OIt ❑ �'3."HICLE / V�551�I� WILL HE 2�2•FLORIDASTATUT�S VSF, TA}[ FOR T8E 4SED EXCLQBIVES�Y FOA &ENTAE, _•-••--.... ....-..._..... �REA50N(S) G1E�Ck'�A I� 8�� TiI�R ❑ SES�LTNCt pRTCE l�RZFTED I l ... ._ ..--•............... ...-- •- •--•......_.__._.._._._. ... ... .--•--••--. ........._.__. . .. , +APk�LICA�iT CER'�IFSCA'1'IQN IfYVE NEHE6T CEKTIF7�TIAT THE VEHICLENEHB�L TO 6E 7RLE0 YdILL NOT BE OPEHfi7EG UP0117ME PUBWC MIOMWAYOIWAYERWAY�OP 1MIS diA1'� 1 ClRTI�Y THAT THE CBhTIRICAIE OP TITLE 19 LOET 6R�eE7RWED. 1 CERTIFI'TWATTNIB MbTOR v6NIC7.EKE9961.wM qSPGAnS�FW uaoN DEFltU1.T aF TNE I.IFN 1�7R�MDIr PNn w NOW�[�t FT/paaASsNrar{ I IiwE n�eT cER71F'P YMNT IAM6I.AWR47LLY OWN 7H�ABGYQ De�GR1tA0 Y9NICL6/MgBSHL,AND MAKH APPWCAtiON fGR TIi'L�IP LISN!0 B81NB RQCORDaD NOiIC9 ID HER�mY OIVeN THA7 TNRk4 IE RN F�aanN�WR177RN I.IAN�Ner�uMRNT��.v�No r►��qH�e�,q�vqen�4 pqaeR�paP As��hran Mel.p DY I.�pNRO�p�ah4Ww pDavR�Uwq pt1RTNQRAmlt4q YG OR�allo 7HQ TITI.�AflAINaT ALL Ct,q�M�, � � urueqR p9NhLYiRe eF PR�uav,r oAc4ns��{�T�MIWKA91w iN8 FnaSvo�No pxuMBNs nNa TWtt7X6 pncY1+QtnTR�n Ik RNGs i►tu�. I SlflnaRurn af pppllcan�l0��r,ar Slpnature otApplicenVCo•Oumer ,H9MV 82041 REVISEI�02106 SCAN CaDF. MVT ._.�..----•--------•----•--------------•-•._......... ......,_.__._..... . . . . 1�N6ERSTAND THAT MY DRIVER LICFNSEAND REOISTRATION5INILL BE SUSP�NOED I�AMEpIpT��Y IF THE INSURER DENIES THE INSURANCE INFORMATIOfV 5UBMITTED FQR TNIS REGISTRATION.