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27146" l 1 `,6 »e� II i ii f/ \'I i /" 1 �\i „iro vvS$ �Y Ir.R NNA • HPARR <%/ 9 IssRS (Z. FARS VEHICLE IDENTIFICATION NUMBER YEAR 22GES3902 76 DATE ISSUED ODOMETER 11/22/17 N/REQD MAKE BEND TAX BASE CODE 000000 00 MODEL/BODY HS MH PLATE NUMBER FIRST SECURED PARTY DOB 1ST OWNER 07/13/17 72946 MOUNDS VIEW ECONOMIC DEVELOPMENT AUTHORITY 2401 HIGHWAY 10 MOUNDS VIEW MN 55112 TOTAL LIENS 1 STOREY CAROLYN ANN 5702 CABOT DR MOUNDS VIEW MN 55112 II MENU 11113 Vkfi?, /a°i �e� i9pnnoe II IIIIIIIII I I II III III111111III1111II1 miir TITLE NUMBER 00Q5YDQ-1 CENTRAL OFFICE USE ONLY ASSIGNMENT i.-`C BYSELLEI T2ANSFEROR FEDERAL AND STATE LAWS REQUIRE THAT YOU STATE THE MILEAGE IN CONNECTION WITH THE TRANSFER OF OWNERSHIP. MINNESOTA LAW REQUIRES THAT YOU MAKE A DISCLOSURE ABOUT DAMAGE TO THE VEHICLE. A FALSE OR FRAUDULENT STATEMENT OF PURCHASE BY ANY PERSON IS A GROSS MISDEMEANOR OR FELONY. ODOMETER DISCLOSURE STATEMENT. I (WE) CERTIFY THAT THE ODOMETER NOW READS (NO TENTHS) MILES AND TO THE BEST OF MY KNOWLEDGE THE ODOMETER MILEAGE: ❑ IS ACTUAL MILEAGE ❑ EXCEEDS MECHANICAL LIMITS OF ODOMETER ❑ IS NOT ACTUAL MILEAGE —WARNING ODOMETER DISCREPANCY DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF MY KNOWLEDGE, THIS VEHICLE: 0 HAS ❑ HAS NOT (CHECK ONE) SUSTAINED DAMAGE IN EXCESS OF 80 PERCENT ACTUAL CASH VALUE ASSIGNMENT: I (WE) CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS, WARRANT TITLE, AND ASSIGN THE REGISTRATION TAX AND VEHICLE TO: SELLERS PRINTED NAME(S) SELLERS ADDRESS SELLER'S SIGNATURE(S) DATE OF SALE DEALERS LICENSE # BUYER'S PRINTED NAME(S) BUYER'S ADDRESS BUYER'S SIGNATURES) PireLlt..P4 O l!N rUK IIILE 1psY bUYEtK (1RANSFEREE). MUST BE SUBM9TTED WITHIN 10 DAYS (Piease Print) pia `. BUYERS NAME ILA 1) (FIRST) (MIDDLE) DATE(S) OF BIRTH BUYERS DRIVER'S LICENSE NUMBER(S) °dap. iii ADDL BUYERS NAME(S) (LA- I ) (FIRST) (MIDDLE) BIRTH BUYERS DRIVERS LICENSE NUMBER(S) DATE(S) OF NI STREET ADDRESS CITY COUNTY/CODE STATE ZIP CODE h\ P. /1 1 i sA:' sss IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? FIRST SECURED PARTY'S NAME (PF.INT NAME) NO ■ YES (IF YES, COMPLETE SECTION BELOW) DATE OF SECURITY AGREEMENT FOR ADDITIONAL SECURED PARTIES, ATTACH COMPLETED FORM PS2017 I STREET ADDRESS - - '—S IATL--. - :.—ZIP CODE -- - I(WE)CERTIFY I(WE)AM(ARE) OF LEGAL AGE, HAVE PURCHASED THIS VEHICLE SUBJECT TO LIENS SHOWN AND NO OTHERS, I (WE) ATTEST BYTHIS TRANSACTION THAT THIS VEHICLE IS AND WILL CONTINUE TO BE INSURED WHILE OPERATED UPON THE PUBLIC STREETS AND HIGHWAYS. ALL OF MY (OUR) DECLARATIONS ARE TRUE AND CORRECT. • CITY JMINNESOTA COUNTY OR OTHER STATE WHERE VEHICLE IS KEPT IMPORTANT - PLEASE READ: ALL INFORMATION COLLECTED ON THIS APPLICATION IS REQUIRED BY LAW AND IS USED TO IDENTIFY THE MOTOR VEHICLE. FAILURE TO PROVIDE REQUIRED INFORMATION MAY RESULT IN )`V`\�i gvaB DENIAL OF THE REOUESTED ACTION. EXCEPT FOR CERTAIN USES PERMITTED BY FEDERAL AND STATE LAWS, PERSONAL INFORMATION CONTAINED IN YOUR APPLICATION MAY NOT BE DISCLOSED TO ANYONE WITHOUT �6e�fi: iA rj YOUR EXPRESS CONSENT. YOU MAY EXPRESSLY CONSENT TO THE DISCLOSURE OF YOUR INFORMATION BY WRITING THE FOLLOWING ADDRESS: el. -.if" Njy- Dr ,, 1 - iaAl.,. PS2700-19 MINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERVICES DIVISION 445 MINNESOTA STREET, ST. PAUL, MINNESOTA 55101-5187 PHONE 651-297-2126 TTY 651-282-6555 dvs.dps.mn.qov SELLER'S NOTICE OF SALE When you sell this vehicle, you are responsible to file the information on the back side of this notice with the Department of Public Safety within 10 days. Please file this information over the Internet at dvs.dps.mn.qov, call 651-284-1234, or complete all the information on this notice and mail to the address below. This notice is not required if sold to a Minnesota licensed dealer. MINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERV CES DIVISION 44 MINNESOTA STREET, ST. PAUL, MINNESOTA 5510 -5187 MINNESOTA YR MK 76 BEND PLATE u \�\N d/yi/�II06WnIn1 \�\, \\ A) e 1 P) .\ 6o/ ISRPaUbn74I1i. 4�\\4L MOTOR VEHICLE REGISTRATION - MDL VIN HS MH 22GES3902 STICKER ft TAX EXP GROSS VEHICLE WEIGHT/BASE VALUE RECORDED OWNER(S) STOREY CAROLYN ANN 000000 IIIIIIIIIIIIIIIIIIIIIIIERR IIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII TITLE NUMBER 0005YDQ-1 VIN 22GES3902 5702 CABOT DR MOUNDS VIEW MN 55112