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SAMPLE ALABAMA DEPARTMENT OF REVENUE MOTOR VEHICLE DIVISION - TITLE SECTION P. O. Box 327666 Montgomery AL 36132-7666 MVT 5-1E REV 03/10 Application For Certificate Of Title This duplicate copy serves as a permit for the operation of the motor vehicle described below until the revenue department issues a certificate of title or refuses to issue a certificate of title and shall continue to serve as evidence of ownership and as a permit for the operation of the vehicle after title is issued. Application Date 3/15/2013 42144839 Current AL Title Surrendering OOS Title - State Trans Code Legend Codes Enc AL Title Gross Selling Price 4 800. 00 Trade-in Allowance. 00 VEHICLE INFORMATION VIN SALTW12431A703680 Purchase Date 03/11/2013 Year 2001 Liens 1 Make LNDR Model DISCOVERY Odo. Reading OWNER INFORMATION FELONY OFFENSE FOR FALSE ADDRESS Reading Type Body Type 4D E - Exempt Cyls 8 Color WHI New/Used USED Alabama Operator Lessee If Different Name KINARD CAROL JOYCE Mailing Address 178 RAILROAD LANE Resident Address City State Zip CENTERVILLE AL 35042 LIENHOLDER INFORMATION FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD Alabama law requires that the certificate of title be mailed to the first lienholder. First Lienholder Second Lienholder LEGACY AUTOMOTIVE 3305 32ND ST. SUITE H NORTHPORT AL 35475 Date of Lien SELLER INFORMATION LEGACY AUTOMOTIVE Physical Address 3305 32ND STREET SUITE H SIGNATURES FELONY OFFENSE FOR FALSE STATEMENTS I THE UNDERSIGNED CERTIFY THAT THE VEHICLE DESCRIBED ABOVE IS OWNED BY ME AND I HEREBY MAKE APPLICATION FOR A CERTIFICATE OF TITLE FOR SAID MOTOR VEHICLE AND THIS VEHICLE WILL NOT BE THE SUBJECT OF LIEN PRIOR TO RECEIPT OF TITLE UNLESS INDICATED ABOVE* I FURTHER CERTIFY THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF* Owner Signature Date I HEREBY CERTIFY THAT THE ABOVE DESCRIBED VEHICLE HAS BEEN PHYSICALLY INSPECTED BY ME AS A DESIGNATED AGENT OF THE DEPARTMENT AS REQUIRED BY LAW AND THAT THE V. I. N* AND DESCRIPTIVE DATA SHOWN ON THIS APPLICATION ARE CORRECT. I FURTHER CERTIFY THAT I IDENTIFIED THE PERSON S SIGNING THE APPLICATION AND WITNESSED THE SIGNATURE S. DA Signature s DA Name DA Account Number 63-05020-00 ATTENTION APPLICANT You can track the status of your title application by entering the title application number listed above at the following website titlestatus. mvtrip*alabama*gov A signed copy of this application shall in accordance with Section 32-8-38 Code of Alabama 1975 serve as a permit for the operation of the motor vehicle described above until the revenue department issues a certificate of title or refuses to issue a certificate of title and shall continue to serve as evidence of ownership and as a permit for the operation of the vehicle after title is issued* Legends EXEMPT VEHICLE - ODOMETER READING NOT REQUIRED. 00 Trade-in Allowance. 00 VEHICLE INFORMATION VIN SALTW12431A703680 Purchase Date 03/11/2013 Year 2001 Liens 1 Make LNDR Model DISCOVERY Odo. Reading OWNER INFORMATION FELONY OFFENSE FOR FALSE ADDRESS Reading Type Body Type 4D E - Exempt Cyls 8 Color WHI New/Used USED Alabama Operator Lessee If Different Name KINARD CAROL JOYCE Mailing Address 178 RAILROAD LANE Resident Address City State Zip CENTERVILLE AL 35042 LIENHOLDER INFORMATION FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD Alabama law requires that the certificate of title be mailed to the first lienholder.

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