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Bill of Sale - Haskins, Andrew_8/20/1974—'"TITCEAOVI9Ffl - _ <BN4NCMN0. ::,_ . :. .... . . .. .. . ._ � . . . ... � , '. �BfiANCMIfvV0p10EN0. ' ' � . � ^ ' ' �. $OCIAlSECUflITYOH` . ' ` ��.� - � " • . , �••' .•. ':� � ' . PPLICANT'SNA:dEOflFEDEflAIID_ABBREVIATION � FEDEfiALID. NUMBEfl � � " ❑TY "' 1 ' 1 . .. � Si4TE : ZIPCODE � '��^j'��}, . Z ,''' $R 1 pep.,Ce,},..RS r�; �. �y�670 - ; �s . � VEH.,MAKE VEHICLEI.D.VUMBEH � VEH.YEAR VEH.TYPE VEM.MODElNO. t: , . , 1� '3 ..,_FO�uLRLENUMBEF�� PUflCHA5E0ATE �� IIEN . WFflv �� ..�� _, a�� 7bl19�bt�o15 07 01 7te o Y: . .' _ FlRSTUENSNAMEOFFEDEPALI.D.ABBREVIATION � �+�i�" " STflEEiADDRES50flFEDERA�I.D.NUMBEfl � ' - 'Y � � ' rJ� .� , . ' _ � ei� . d - CITY� . � � STATE"� --ZIPCODE . ". . - . -. .- ... . .. . „ - 8 . - . , . ... _ -_ SECONDIIEN'SNAMEORFEDEFALI.D.ABBflEVIA710N � $TpEETADDRE550NFEDEFALI.D.NUMBEfl � �� , , ' � ��TY� STAtE� - LICENSE LICENSE FOflMS - _ . { , � ' YEAfl NUMBER SIGNED 8 � . �, � 9 ' .. ' . .... �` ' . �_ . � . . .. .. . .. . . . . .. ' ^ , . .�+' 1ha lar r.�vv�s �Aat you 000�v br Cenifimie of i-tle .lK i d y�drom ih doie af o�«hme 1 a m ior .en�d.. Ihen n a,ddin uan �•• ` for Fallor� io do so. nimch GnJ mie o! i��le a i d 6 II � 7 �/ O�IIJ of 35.00 �, ; al�ase lorm on ra•vse�s�de ol �ile' Svovo.�3ng�do�um � � nde�ed.iiheihas oo ��h iill shn�a 6e rsoedl•d�tendened pce,s�.lifia �py5�berOleas�d cppllmlbmbr :ic • plu�ea or v o( L<ense plaiey F m S fyned Sta�e lea lor p01y� g(or Iitle ii 55.00 �� 'a�d� EO On —"- - ' � TITIENUMBEfl � •� `�'� BflANCHNO. 'BMNCH��INVOICENOY� ___ __ _._. _ ___ .. . . .. �- �• .. r . _. :p:�. .. .. ... . _ _ _ . .__ _ . . . . _ . . . D .... $Qqq�SECUFITVOF . , APP�ICANT'SNAMEORFEDEflAII.D.AB8REV1ATI0N 3. �` D � � O FEDEflAII.D.NUMBEp • � - �� N _: y � . . ' � y; n - � , p STflEETA0DRE55.'.-'�, .-��.._.�__. -. v' - � . .' ` -..N...�. - T ::_� .. ��- x„ ^- _' . CITY }. '� .. . _ . ST4TE � 21PCODE � � . . , O ' T T VEM.MAKE � VEHICLEI.D.NUMBEfl ' VEH.YEAR VEH.TYPE VEM.MODELNO � "�--.:". T� V .:- . � P ., ._ ' . ;,y Y . ;' � E.. ,� . .... . . . .. . . ' P - . �+,• FORMEFTITLENUMBEH. PUflCHASEDATE UEN WFRS � ' � E I. ' . . ' H . � �� >-` .'FlHSTl1EN'SNAMEORFEDEFiALI.O.ABBPEVIATION � ��N '��'�� _ T . . , . STREETADDRESSORFEOERALt.D.NUM9ER : � ... q'"' � .. '. T . -:: � 5 � CITY,� . � . STATE � • ,ZIPCODE� � . .. H . _ ' . , . . . . .. . . . 5 •,:. '- � n, ... . .., . . � t ° p .' SECONDLIEN'SNAMEOflFEDEHALI.D.ABBFEVInTION - ��' A - E. �-; _ � SiqEETADDRE550flLEDERALI.D.NUMBEq p � `.. � �'� �� . A - `". . . ' � . ' . ' . E . � ' �CITY � . . . . A _ ' <.: , , ..;'. ' '. . . . . STATE �ICENSE LICENSE �' FOPMS � - ' �'�:' � - ' : � ' . YEAR NUMBEfl SIGNED � ' i __:i__ '�.:.,_ � : � `-' '"19-��.,__ � - . . _ . . __._ .. "'_ _ . �' �� '.GflO55REfqIt8A5ETAXAFFIDAVIT I(WEIHEflEBYCERTIFYTHAT5ALE50RUSETa%ONTHISVEHICLEWASPAIDASINUIU7E,DBE},QK/,.. ''n , � �� $ELLINGPRI � LESSTRADEIN� AMOUNTSUBJEQTOTA% AMOUNTpFTA% DF�lF11 � �P�xp1 .q(yp[ �'l 6�� .� - f^ ��o'iio S —, r �..,.2a�`QCl _:. . s. � _ . ._ _ � • - — S , _ S - 3_oa- -- - `°` � . SELLEflSNAME 1 'r r.- .. . . . ' ADDflE55 . CITV " 6fAlL-IIPWOE �: :d�FZOFt L�^R.GR�GF N"•?�"?i< 7�7 �'Eii' il:i:t�:�g �T�'tC,'��,'i'�r:: '�Fj� . TO BE FILLED OUT BY�A POLICE OFFICEfl FOR OUT OF STATE TITlES. Si4iEOFIN0IANA l APPLICANTIS151GNATUftE(IFSIGMNQWflA � I MEREBY CERTIFY THATJ:PENSONnLLY E%AMINED THE FOLLON'ING VEHICLE COUNTYOF I COMPANY.Al50GIVEPOSITIQIQ ' ANDFINpTHE1DENTIFICATIONNUMBERTOBEASfOLLOWS Il � . VEHIC1F��DENTIi1CATIONNUMBEfl M4KE _ YR, ^ * r SS' � _ �.� - ��- , � • �� _. � i 3 �C: `-z i ..-. . = .. -` ,• i _ � � �-t� OFiICEflSTITIE ��:' n f :.__t� - CITY . . . - ' ' SGBSCF�DAN'D3WORk L%� (� �� '� .. . . �� °� ' BEFOflEMETMIS c1q,E0F •T�iT- � � � " 'OFFICEqS51GNATURE . DATE �_ NOTAflT"SSIGNATURE MYCOMMIOSSIONIX%A�E.S ��__ . � - � . . : .' '. ' ,.. 19— � _ , _' �STATEOFINDIANA • APPLICATIONFORCERTIFICATEOfTITLE • BUREAUOFMOTORVEHICLES� - _/�PPLICANT'.�AECEIPT Toppanolt�iscopvmEe.alidaroEOnbackanEWrnis�eplienpqlAacBOttompantobe pMandonba�kepdyivantOOwnR `. 1' ', .r_......?6.<.C.t�." ....,..\.'£ _,...� .. .:F.. . ... .,..._ ._ .. _.:> ......_.. __ _.._.._�_.. ..�_,.�:�_ .. ._.