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TRANSACTION ID'S <br /> �_.. # AGY# SUB# RPT# j , I l <br /> L # TRANSACTION <br /> . - 836439 <br /> 28 6 CAS 2635 STATE OF FL ORIDA T# 584278246 <br /> ,., <br /> AUDIT # APPLICATION FOR VEHICLENESSEL B# 528312 <br /> CERTIFICATE OF TITLE <br /> MAKE or BODY VEHICLE COLOR WT /LENGTH GVW /LOC <br /> TITLE NUMBER VEHICLENESSEL IDENTIFICATION # YR. MAKE MANUFACTURER TYPE <br /> 3311433 11 1347121642 11 1969 PIED I I HS LINK 1 1 143 <br /> VESSEL WATER FL NUMBER <br /> DATE OF ISSUE TRANS VEHICLE USE HULL MATERIAL PROPULSION FUEL TYPE <br /> MO. DAY YEAR CODE <br /> 06 101 09 1 1 TRT 1 1 PRIVATE 1 1 1 <br /> BIRTHDATE RESIDENT CNTY <br /> SEX MO. DAY YEAR Y N ALIEN RES.# <br /> Applicant/Owner's Name & Address <br /> CLIFFORD E MCCURDY M 103 12 149 I X I 28 <br /> 39353 TABETHA AVE tst OWNER FL/DL# OR 2nd OWNER FL/DL# OR <br /> ZEPHYRHILLS, FL 33540 F.E.LD.# UNIT # <br /> M263105490920 1 I <br /> VOLUNTARY CONTRIBUTIONS <br /> AGENCY TITLE FEE SALES TAX GRAND TOTAL <br /> FEE <br /> 4.25 1 35.00 I 105.00 144.25 <br /> Action Requested: TRANSFER TITLE Brands : <br /> ODOMETER <br /> PREV. STATE DATE ACQUIRED NEW USED ODOMETER / VESSEL MANUFACTURER ❑ DECLARATION <br /> FL 12/03/2008 XX CERTIFICATION <br /> LIEN INFORMATION DATE OF LIEN RECEIVED DATE FEID # OR FL / DL AND SEX AND DATE OF BIRTH DMV ACCOUNT # <br /> NAME OF FIRST LIENHOLDER: <br /> SALVAGE TYPE <br /> ADDRESS <br /> SEI J .F.R INFORMATION <br /> NAME OF SELLER, FLORIDA DEALER, OR OTHER PREVIOUS OWNER <br /> ADDRESS <br /> DEALER LICENSE NO. CONSUMER OR SALES TAX EXEMPTION # <br /> INDICATE TOTAL PURCHASE PRICE, INCLUDING ANY $ 1,500.00 <br /> SALES TAX AND USE REPORT UNPAID BALANCE DUE SELLER, BANK OR OTHERS <br /> TRANSFER OF TITLE ❑ PURCHASER HOLDS VALID <br /> IS EXEMPT FROM EXEMPTION CERTIFICATE INDICATE SALES OR USE TAX DUE AS PROVIDED BY CHAPTER $ 105.00 <br /> 212, FLORIDA STATUTES <br /> FLORIDA SALES OR ❑ VEHICLE / VESSEL WILL BE <br /> USE TAX FOR THE USED EXCLUSIVELY FOR RENTAL ❑ SELLING PRICE VERIFIED <br /> REASONS) CHECKED ❑ OTHER <br /> APPLICANT CERTIFICATION <br /> EWE HEREBY CERTIFY THAT THE VEHICLENESSEL TO BE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HIGHWAYS/WATERWAYS OF THIS STATE. <br /> - I CERTIFY THAT THE CERTIFICATE OF TITLE 1S LOST OR DESTROYED. <br /> - I CERTIFY THAT THIS MOTOR VEHICLENESSEL WAS REPOSSESSED UPON DEFAULT OF THE UEN INSTRUMENT AND 15 NOW IN MY POSSESSION. <br /> EWE HEREBY CERTIFY THAT IMIE LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL, AND MAKE APPUCATION FOR TITLE IF LIEN IS BEING RECORDED NOTICE IS HEREBY GIVEN THAT THERE I5 AN <br /> EXISTING WRITTEN UEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY UENHOLDER SHOWN ABOVE. EWE FURTHER AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS. <br /> UNDER PENALTIES OF PERJURY, 1 DECLARE THAT ,I. HAVEREAD THE F np °�'�°r'. `TM' •�°"" •• <br />