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CNTYs AG11e_ SUBe_ RPT� ���I ��4��������'I �I� I T+� �06458C> � <br /> 28 i 21 5319 � �1r <br /> -•••--..�•--...r. � 989I73526 <br /> � STATE OF FLO�IDA I� 7644�50 <br /> ��R� APPLICATION FOR V.EH1C�,�IVESSEL s� 58417680 <br />� I.. ....., . ' � , <br /> ' CERTlFICATE QF T�'��E -�---� -�--._._....__._..__ . <br /> TITI.E NUMBER vEFtICL�fV�gSEL IDET1TIfICATION o A YR.Mn1(E �E'� BODY VEHICLE COLOR will�NGTH GYwn.00 <br /> MANUFAC7t,1RER TYPE � <br /> � . ...._ ._._....__.... _. r..._..... ..._.._..._._....---•..._ . ._. _._._._._... --••- � � <br /> ; 21396442 ;K822SFA � �98z i 1"' <br /> , —_.-- , ._... ! ��� _.__. _, 1 �_..Hs� -I�� .. 3a `� ; <br /> I OA7EOFISSUE TRATdS v�HIG1.EU8E HW� PROPULSION F�iEL ��E� WRfER FLNUMBER '�TW <br />' ; M0. OAY YEAIR COD� MqTERIAL TYPE aESTlZUCTION <br /> . . . . ._._.._. ._...__...... .. <br /> .. I - • •-•- ----------.. <br />��, �09 ;29 : 17 , I TIt'T j PR�VA,7'� : �.__.._.__ . . .... .....-_•••--- --._.......,_...... <br /> i._...�.. ..i � <br /> ....__i_T._�..___'__"'_'�_'_..._..�� .�. . ... �_'_'_""'_._._... <br /> eiRrrromrE R�SID�N7 �� <br /> SEX M0. nAY YEAR Y N ALIEN RES.i I <br /> AppflcanVOwnet'eNemeBAetlress ___... ... , <br /> ��S�o�,�.L� I . . . _..f:�....�.1:...::.1 .X _ ►�$ <br /> I POBOX753 . . �._..I_. _. �..... <br /> I �.�.p�R�]1r Tr5',FI. 33539-0753 18i OWNER FL�L}LO OR 211d OwNFR F4�1��OR <br /> F E�I,O,a WN11'0 I <br /> � 814854323-01 , �— l ' <br /> —I <br /> V6LUNTARY COMRI6117�pNS <br /> I _... . _ . . ..,. ..... .._._.........._.._ ._.. ....., , <br /> A�ENCY 71tLEF�E 3RLE3TA7C GRANDTOTAI, i <br /> • I � <br /> - — <br /> . <br /> °: i . . ...........__..__._ �.25 '• �_ 73.50 I__ 35.001 1.....---_ 112,75� � <br /> I .._..... _ .... _..........-�--�----•---•--. _..... � � : <br /> i Act.�on R�q��Qtad e TRA�NSFFR T'ITI,E a��►�ads: � <br /> I , <br /> � . . ..-�-�---•------ � <br /> PREY.STATE DATE ACQIJIRED N�yV . .U8ED . .ODOMETER/VE33EL MANUFACTURER OQOMB 1'Eli.--..Y. I <br />� OECLAkA7TON <br /> ce�n�cnnoN <br /> FL 49/192017 . � � <br /> .... ..... .. . . . .... •L----_..,._._�_...-- •---._..._._..._... . ... <br /> . .. ........._ ._...�__...._._.-•----•••— <br /> rLIEN iN�'ORMAT(Q�1 DATE OF LIEN R�C�NEO DATE FE7O 0 OR FL/DLANQ S�X1Wp�A'�OF F3�RTW DMV ACCAUNT� <br />!I II �NAM�OF FIRSTI,I�NHp�DFR; <br /> --....._....--•----.._._._._..._._._..-•-•-----._........._.......,._... <br /> I IAbDRES3 3ALVAOETYPE <br /> � . . .. ..........__.-•-•--•••-- ------..�_.. .... _.. . .. ....._..-••--•-•--•------._._......___...__.._ __...--•..._.....--•--. ..._......_. <br /> �SEJ�LER iNFORM�1,T10N . � <br /> NAME OF SELLER,KLORIDAbEALER,OR oTFiER PFt�V10US OWNER <br /> ;AD�RESS <br /> DEAIERtICEN5EN0� •_--••-•-..... �_.......__.._ .... __. _._._. .. . .._.. _. . <br /> ICONSUMER OR SALES TAX EXEMPTION! <br /> ... . . _... _....... .. ._.. . .... ._....._.__.... ... i . ........ ..__. . . .. <br /> � SALES TAX AND USE REPORT INdICATEI'�TALPURCHA8E PRICE,iNCLU0INOANY $ 500.00 <br /> UNPAIO 6AfANCE DUE SELLER,BRNK df!07H�R3 <br /> .TEiA1QSFER OE TITLT C� PIIRCH�B�R FiOLDS VAirIa .. . . .. <br /> �S EXEMPT SROM EXEMPTI0�7 CERTIFICATE INDICATESALESORUSETPJCDUEA3PROVIbED6YCFiAPTER $ 3S.00 <br /> �zo�xp,A. s�as oz� O v��tzcz,� / v�ss�z� �zz��. z� a�z,F�.oRio,asran.rr�s ----•--------.. <br /> IISE TAB FOR TEE IIBED $%CZdJBIVES+Y FOR RENTAL <br /> REA50N(S) CEiEC�D ❑ �TiiSli ❑ BELS�IN6 PRSCE p�RIFT�D <br /> � _..._..._._.___.___—...._._.... ----_-_•--•••-•- - ._. .....--••-••--•••._ . . .__...--•--.... . • •-.._.._..---_..-•-_•-•-----••---•--- <br /> APPLICIlNT C�'�i�A'xb'xCl#'J.'x0�7 <br /> IIWq 114REEY ElRTIrI(TNAT TFIC VCNICLENCBEELTO BE'fiTLEO WILL NOT 9L�PBiA7E0 UPON Tt1E PU9LIC HIOMYYhYHMfqTEFiWqt9 OF'R119 BiATE. <br /> I�f C�RSIFY TMAT SNE CeRTIDICAT�Cp TITLE 13 LOST OR DAaTROY104 . <br /> f cCttl7rY THAY THIS MOTC11 V[HI�1WlE�GL WA611l�06DlEElD U�ON ClJAULT C�TNE LIlJ1 INETRUMlHT AND Is NOW UG NfY POssESEION. I <br /> �uwe N�erce�inas urvE uuyw��Yvwn ineaeove oee�aiaeo ve�ii��ervEoaeL,ano�e�t�P�tCATfON ROR TIfL9�IP LIEN W D�INO RECORPAD NOs�eE IR N4REOroryAN THRT TH��tR la AN <br /> �exTa�rmo wairl'�tr LiQN IN87RUM9tiT INvo4VINo rHll�+eH��LAnr4arpl.pelseR��AoMevqpNe H4�.p pv upNHo�een eHowN aeev�uwe�uRTHeRnu�e m oeF�un THe nx�aoniNaTau cuuMa. <br /> i <br /> � III�NER PEN/LLTIEB OF VERJIfRr 1 DQCLARQ THAT I HAYE REAO THE FOREDOIN9 DOCUMENT ANO TH0.T THE FACTB BTAT�fN ITAFlE TRUE <br /> Stpnetute of AppllaqrrHpwna� Slp�ature ofAvpllcanUCo-Owner <br /> H3NN820�1REVISEOOt/08 SCAr1CODE ]VjVI <br /> . . . .. . ....... ._ . . . .. . . _...._.. ._. __.. ... ._... . ... .. . . <br /> I UNDEFtS'I'AND THAT MY DRIVER LICENSE AND REGI37RAT10NS WILL 8E SUSPENDED iMMEDiATELY IF THE INSURER DENIES <br /> THE�NSUFwNCE iNFORMATiaN suBMl'rT�p FOR THt3 REGISTRATION, <br />