(To Be Filled Out By Seller)
Make ___________ Model ___________ Year ___________ Style ___________ Color ___________ Odometer reading ___________ Vehicle Identification Number __________ Date of Purchase ____
Seller's Registration number _______ Have you previously filed application for title for _______ this vehicle:
Yes ___ No ___
Seller's Name: __________________ Street and No. _______________ City: _______________ State: _________
AS OWNER OF THIS VEHICLE, I HEREBY TRANSFER OWNERSHIP TO:
Buyer's Name: ____________________ Street and No. ______ City: _______________ State: _________
For the Sum of $ _________________
I purchased this vehicle from: __________________ Name Street and No. _______________ City: _______________ State: _________
I DECLARE UNDER PENALTY OF PERJURY THAT THE STATEMENTS HEREIN CONTAINED ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
If Required By State Law
This Section for Notary:
State of _________
County of ________ [COUNTY]
On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
My commission expires: _____