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Other: 6. Make 5. Model Year 9. Circle Color(s) of Vehicle 8. Model # 7. Model Name O. ORANGE 1. BLACK 2. BLUE 10. Cyl/Pass/Doors/Wheels 11. Trans Auto Manual 12. City/Town Vehicle is Principally Garaged 3. BROWN 4. RED 5. YELLOW 13. Expiration Date 6. GREEN 7. WHITE 8. GRAY 9. PURPLE Month / Year 14. Name of Owner(s)/Co/Corp/or Sole Proprietor Owner #1: Owner #2: 15. Owner # 1 License # / ID # / or SSN Date.

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