| Year: _______________ Make: ____________________ Model: ___________________ Style: ____________________ Color: ____________________ VIN #: ___________________ Odometer Reading: _____________________ Original Date of Purchase: _______________ I also state this vehicle is not stolen, salvaged or a flood Vehicle. Seller's Name: _______________________________ Address: ____________________ City: _______________________ State: __________________________ Zip Code: _________________________________ Buyers Name: ______________________________ Address: ______111 Reagan St.__________ City: _______West Monroe___________________ State: _________Louisiana___________________ Zip Code: _________71292___________________ For The Sum Of: $__________________________ I declare under penalty of perjury that the statements herein are true and correct to the best of my knowledge and belief. Seller Sign: __________________________________________Date: __________________ Buyer Sign: _________________________________________Date: __________________ Notary Section: Stamp Here: Seller Signature: _______________________________________ Notary Signature:_______________________________________ My Commision Expires: ________________________________ |