| Mail Form & A Copy of Your Drivers Lisence. Make Payment Out To: Tina Burnette 111 Reagan St. West Monroe,La. 71292 |
| Completed paper to mailed to this address; Name; _______________________________________ Address; ______________________________________ City,State,Zip; _________________________________________ Daytime Phone; (_ _ _) _______________________________ Email; ______________________________________________ Name title to be issued to; ________________________________ Address; ___________________________________ City,State,Zip; ________________________________________ Method of Payment; __ Check __ Money Order Where did you learn of our services? __________________________ AFFIDAVIT AND BILL OF SALE; I the undersigned, do hereby represent that the vehicle described below is legitimately owned by me, that it is not stolen, financially encumbered, salvaged or fraudulently acquired, and that it is not my intention to use the services of Antique Car Title Service and any or all their affiliates or associates for any illegal or fraudulent purposes. Value stated in sale price is the actual price i have paid for the vehicle or have invested in the vehicle.I am not using Antique Car Title Service and any or all their affiliates to avoid paying taxes i owe on this vehicle. I am not using this service to avoid safety or pollution laws. I am only using this service to help me acquire a legal title to a vehicle i own. I do hereby release Antique Car Title Service and any or all their affiliates or associates from any liability arising from my misstatement of any fact contained herein or any fraudulent use of this document. By signing I also acknowledge i have read the accompanying information and understand what i will recieve. NOTARY; (This must be completed in order to process form) Seller Signature; ____________________________________________________________ Notary; ____________________________________________________________________ My Commission Expires; _____________________________________________________ THE BILL OF SALE BELOW IS FOR REGISTRATION PURPOSES ONLY AND DOES NOT CONSTITUTE A CHANGE OF POSSESSION. LEAVE "BUYER" AND "DATE" BLANK. BILL OF SALE KNOW ALL MEN BY THESE PRESENTS; Date of Sale;_______ Day Of; ______, 20__ For value recieved, I the undersigned do hereby transfer, sell and convey the said ________________________________ (Buyer) One Year;____________ Make; ____________________ Model; ________________ Body Style; ____________________ Vehicle ID Number (VIN); ____________________________________ Color; ______________ CC's if Motorcycle; ______________________ # of Cylinders; _________ Price; $________________ Print Vin Again Very Clearly; ____________________________ Gross Vehicle Weight; _______________ Drivers Lisence Number; _____________________________________ Date Of Birth; __________________________ Seller Signed; ____________________________________________________________________________ Seller Print; ____________________________________________________________________________ |
| 318-801-9750 |