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USE ONLY DEALER EX Value ($) Sales Tax Status Information GI Permit Permit Info. Number Lien Filing Code (Assigned by DMV) ONLY INSTRUCTIONS 1 IF NF Jurisdiction Expiration Date / NU OD OV PA RC SA Out of State Audit Rate Date Issued / / New Class Facility ID Number / SO I T P SP SS SV Is there a lienholder? If Yes , enter the information below UNLESS the vehicle will be transported out-of-state (in that case, Yes No advise the lender to perfect the lien in.

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