EFTA00310683.pdf

VcC VOID UNLESS 'FICIAL VALIDATED HERE BY slECTICUT CONNECTICUT 5-1*ATION TIFICATE OWNER'S SEX / STATE MM O F s t e" — I CT RESIDENT RESIDENT ADDRESS ff/DaTerent Ir m A(anng Addees . PC Sorts NOT O FE0ISTRATIDI CIA: 121 Stp: 349 accnrabic) /SC: 01 Elf mate: 36/11/11 (10 Code) p iES❑NO IF CO•OWNERSHIP Thor/VIII: 13819K Nate: 6Ria n JOINT/OR Requires ONLY ONE rl COMMON/AND - Requires ALL 2r. ‘iJi. " fi / L--I signature to transfer ownership '—' signatures to transfer ownership ration Date: 06/11/2013 CO•CAVNERIT SEX CCnOWNER'S BIRTHDATE CO-OWNEWS LICENSE NO. OFT ID STATE es Tax WM): 12148.00 ❑M 0 F re: 75.00 OW/001 I the tumor of five (S) or more vehicles that are registered in my name. ether ordrodualy or DYES INITIALS e: CEO AIR 4.25 004/048 ma. (2)10o not haves's:ease to sell. repast. recycle. base of real motor wiled°. : CU AIR 5.75 OD4/016 lE NORMAL COURSE OF OPERATION MOST FREQUENTLY LEAVES FROM, RETURNS TO OR REMAINS (For property lax ) : 3AFEll FLT 5.00 IITIV057 1707/001 vehelo Is leased) LESSEE OPERATOR LICENSE NO. CONNECTICUT LEASING LICENSE NO. : TITLE ?3.00 Ri5P.A0FEF. 10.00 009/014 umber and Street) (Geyer Teen) (State) (Zip Cody : S1,9 TAX 769.33 0001009 MANE MODEL NAME OR NO. BODY STYLE MO. Set.. die) 1/4 Iil>. 111 ,67/4318601 113:2111 11:23Att 894.50 2.t 70,1- t-tc;QQ- " - ..- =.. ::c-I 0 1- t-; I+ b ow CBS • R Mactiman of Two) ,,-‘ COOMETF_R READING (ANeage) NEW OR WED COMAE USE 1 IlF.W.3: TOTAL. *0029* 894.50 8,74.50 Plastic Pit FOR E VEHICLE ) 1 SEAT ❑ YES 0 NO (p I) q -; NEW BUSED 0 D U YES NO NO. STANDEES CARRY SCHOOL CHILDREN? COSA. CARRIERAIS DOT NO. (IIengem" • WT. RATING HAZARDOUS MATERIA1 INTERSTATE COMMERCE TRAILERS • Rear Ilghb required. Brakes resridlled IT ❑YES NO BYES 0 NO toothhoxi must be In accordance with CGS 14-252. I URRENT ER DATE OF LIEN SECOND IJEN-HOLDE f3trAny)". cw mei GA". Lingth DATEM nhicle OF SEC60118 ;D:EN I Li., phiehiche puntaggags ADDRESS OF LEN-HOLDER ADDRESS OF SECOND UEN-HOLDER ,fisee(21) ) I _ INSURANCE COMPANY NAME (NN Agent) AUTOMOBILE INSU NCEPOLICY NO. ,,_.--- ( AUsATONeye/ o PG- R t I ,.....\ NAME OF SELLERS/ (W2 Cfmnilt trade tan names) DATE VEHICLE PURCHASED i i / S. MLLE" IET sawrs ADDRESS ---c1 2 -:ei epsiFINI 61 0 has i kr ) op,. 0.003 PURCHASE PRICE (Be or Sab 'spoked) I G eAri .-q0 4T- ST. N\/ ii • r-1, c.-7- IF TAX READ REVERSE SIDE OF THIS CODE NO. EXEMPTION INFORMATION (IIleased vehicle lessor lex number a . EXEMPTION IS FORM. SPECIFY CODE AND ANY TAX Exempnoil CLAMED ADDITIONAL INFORMATION. IDENTIFICATION NUMBER OF TRADED-IN VEHICLE YEAR MAKE CT DEALER LIC. NO. CT SALES TAX PERMIT NO. S. DIALER gpApigAguoti TOTAL SALES PRICE TILLMAN ALLOWANCE NET SALES PRICE STATE TAX COLLECTED DEALER SIGNATURE DATE SIGNED X The undersigned can** that there are no bans on this vothcH motet those specified above, the inainince reward by Connecticut law is in *flog end era' be mantainecl ding Mis regetrabco POHL oil property tee doe any CT Taxing AulhOgy lot ny vent* previously registered In myfour names) have Dee pad. It other than Passenger reitsbelion the TOOTH a *Differed In accord ace MI Menulacturees Maximum Gloss VaNcle Wephl RhIinp The Internist= provided to the Commis's:mei of Motor \Tacks herein if Sitferbed by me. the undersigned. under B. penalty of See sleeveletII accatence ugh the provisoes of Seneca 14-i ID and 53.4.151b of the General Slandos I undoestand that if I make a statementwlvcb I do not believe OWNERS lo be True. TAM PIM b WNW Die Calumniator. I era to autoci to proseculiOn under the abovitnoesO laws :‘ =HARM, / TATE A DATE SIGNED CO-OWNER'S SIGNATURE DATE SIGNED \‘,. ../. C(..., I Al—, A/i713 i4 V- ^1 i — X ' DMV OFFICE S ONLY , 4 new has - 75 - saw Ss C.C. -. , S.C. TY RE TRATON MARKER PLATE NO. CAA temp. can. transfer / N al‘ iron .(claiiiieTh, i .-------• ( .6 litS......- ' D ..).. ..„....-.-r PRi07 EXPIRATION DATE ; STATE ' .) :1781-3- TAX TOWN RESTRICTION CODE sub. mg. ortifeiiions b cf O TAXABLEaCE _ ..4 HIGHEST FEE PAID iv\,_. ) -7 of ix)/ Y PL. Into. eel /`/ tIll IlE0 4-10 N i lk - areca l -s- e) ;gmeaoind r- EFTA00310683