Loading...
Bill of Sale - Horton, Junior L_6/17/1974��r� . . ... .. . ._ � STATE OF INDIANA ICATION FOR CERTIFICATE OFTITLE •-B�U O.FMQTOR VEHICLES r � ` TITLENUM6Efl<-� _ • �HNO. BflA' VOICENO. )'�_3'e.' . � • . ;. ��� "6'� _ SOCIALSECUHITYOR � qppLICANi'SNA\tEOflFEDERALI.0.PB8flEV14T10N : '� �� _ JC'RIO?i L ScOr GRr��e: RC,•r. n,y �- � STflEETADDPE55 � CITY - _ Si4iE ZIP�ODE Z . 72p F� BR�IiDi��Y... P::Zft��'i0`? Zi :i76T0 � . VEH.MAKE VEHICLEID.NIIMBEfl ,VEH.VEAfl VEM.TYPE VEH.MO�ELNO. a� 73217 53 ac 21� FOFMEflT1TlENUMBEfl � PURCHfSEDATE LIEN ' N'FHS �• � ' a- 73I19637ti50 06_ 1� 71� 0 y � � . _ FIflSTLIEN'SNAMEOFFEDERA�I.D.A90PEVIATION • SiflEETA00RESSOFFEDERALI.D.NUMBER � _ ��� i.�. :_-._ .'"_�'i� __'_ . - . .. _. . . _. ' . .. . . . � CITV . � STATE' ZIPCODE .. _- ' � . t . - ..— . -- " � - -- . 6 . " . SECONDLIEN'SNAMEOHFEDER4LI.D.ABBHEVI4TION STflEETADDflE550flFEDEflA�1.D.NUMBEfl' ' - ' _. _ ��TY STATE LICENSE LICENSE FO(IMS � � - YEAfl NUh1BEfl SIGNEO • 8 19 , ! - � . �. -. .. . .. ihe la� .eqoiru �hm yoe oo�v �or CenJimie ol iitle �iihin ien doys lrom iM1 dme o� o��cno„ 1 a moio. .ehide. ihere �s dellnquenry pg�p��y pf 55.00 for foilun �o do so. <imah Ceriifiame o( tiile msigned by sellv �or iher legol e.iden�e ihm fnle should be iasuedl. On endorsed iiilsi, Iia�f IpUSf {fe �eleosad � release form on ivvane side a( iitle. Su000riing doavmems surrendered wiih ihis po��mnm c nnm be . rorned �o ihe aoelimnl, ihero mu37elzo he an � apD�ka�ion !or Ik�nu pimes or banafer o! I:ceme plo�ei. or Form 5 sgn¢d. $ime Iee (or op0lying (or iiJe is 55.00 .� . TIT�ENUMBER BflANCHNO. � BflANCHINV0ICEI:O. . . .. _ " � FEODEfiALLDN MBEfl APP���ANT'SNAMEOflFEDERAl1.D.AgBREVIATION p � O . .. ., . . . .p " ..- N' ; T STFEEfADDflE55 CITY STniE 21PtODE �0 ' ' i� " .. . . ' ' ' � .. . r T� VEH.MAKE, VEHICLEI.D.NUMBEfl __ VEH.YEAq VEH.TYPE VEH.MODELNO. �:=?�� I Y "_ � P :_..r._... .- . f E � � . ;� :i:�'-:_�P . . , FOflMERTRLENUMBER PUHCHASEDATE •LIEN WFqS ,��`��'%�'.E' �' � ' ' I - N . .. � � . - ' . � ��1 - . . ' FIFSTUEN'$NAMEORFEDEflALI.D.ABBFlEVIATIpN N - T STREETADDRESSOHFEDER4lI.D.NI/MBER . � - ' H . � . . . . T . 1,. • H . 5 ��TY ' STATE ZIPCODE ' 1 ' � .. � � � . . . S . .. p. , � . . . , . � . p SECOYDLIEN'SNAMEOflFEDEflALI.D.A9BREVIAT10N A ' �� E STHEETADDRESSORFEDEflALI.D.NUMBEq ' R � ' � � a E A � . ��Tr . STATE LICENSE LICENSE FOFMS ' f �. . YEA�� NUMBEfl SIGf�p . . ... " __ '__'_"_____ "" __ 19 Z . .� ... GflOSSPEfAILdUSETA%AFFlDAVIT-IIWEIHEflEBYCEflTIFYTHAT5ALE50flU5ETAXONTHISVEHICLEWA5PAIDASINDICATEDBELQ$1,� � � , , SE`L��FH1C� LESSTflADE-IN Ah10UNT5UBJECTTOTA% AMOUNTOFTA% oeaen ert�xa nppt Rp��,q,� - 5� 13�i , S _.. S 2ao ;oo Ss ao _ ic- � .. - SELLEft'SNAME , . ADDflE55 CITV 6fRT6LPWDE . � � L I FJEF�S • _ 26Q6 T03.^�R HF.IGRfi3 P=;Zt9.":s i TO BE Fl�LED �OUT BY�A PpLICE OFPICEfl FOF OUi OP STATE TIi�ES. STATEOFINDIANA APP�ICANTISISIGNATUflE(IFSIGNINGFORA � 1 MEHEBY CEHTIFY',THAT I PEHSO4ALLV EXAh11NED iHE FOLLOINING VEHIC�E [OUVTYOF COMPANY,ALSOGIVEPoSIi10I� ANDFINDTHEIDENTIFICATIONNUMBEflTOBEASFOLLOWS' aIi��o� 55:. - VEHICLEIDENTIFICATIONNUMBEfl MAKE . Yfl. . .�.: ' � �.. . . . . .. .s _ � _ � OFHCER'STITLE � . � OTY ' 95 IB �\ O - °i'iC.'1 1T 7 . • . ' ` BEFOHEh1ETHIS DAYOF � ' OFFlCERSSIGNATURE' -� � _ DATE NOTA��GNnT�RE- /% MMISSION E$ • � t i ' �, . .. �Vi�'��/� MO..: ^. -Y0. � . - ' f .!'•.� �-':i ��5� . STqTE OF�INDIANA • APPLICATION FOR CERTIFICA E OFTIT • BUR U OF M TOR VEHICLES /�PPLICANT'S R EC EI PT Top Oart oi �his copy ro Ee vaGpated on back anE IumishaG lien �olCec Bmrom Oart ro be validateC on Eeck and pivsnta ownm. -;o . t.""••_ _' " . . . . . . �