EFTA00124047.pdf

Object 006E63WJ (Page 2 of 18) Page 1 of 2 .0T l0' - Lender IDES" Capital One Application Status Customer information nt Name: APP ID: 129939171 App Income: $6.625.00 Total Income. 56.625.00 Status: Approved (As Submitted) td eContram Status AvarIatne Approval Date 12/12/2016 Approval Expiration. _ 0110712017 Vehicle Information Nal/D.Year: Used 2015 Make: JEEP Model. WRANGLER trim. UTILITY 4D UNUMITED SPORT 4VVE) V6 VINE: 25000 Sidearm: Boo'. t I ^ VO]C 0 $29175.00 ail 2 39171RNY Capitta1/ 9 Financing Information 1;1 I Auto Finance Ao roved Product. etall Tier Leven ter 4 Term •2 Amount A roved. 1. Total Dealer Fee Rate r.64% Max Panic lion .00% 'Customer APR cannot exceed lower of state nut or 24.99% Approved Structure Its Price. $25.000.00 ront End Products. $AC0 down: $6000.'. rade $0.00 ebate $0.00 ved rent nd. . 1•.00 fl yeti TaL: $2.392 arrant : AP cis Life $0.00 • dent/Health- $0.00 A ovedA7F $21392.00 A LTV 94: 71. -% Clklc hire to update directly in Dealer Navigator Stipulations POI not required based cm curled deal structtre. Regukement ma change if deal structure changes Standard Comments Submitted deal structure meets COAF approval criteria. Max Amount to Finance for this application up to $50000.00. Buy rate and/or fee will increase for back end %>= 15.01% of vehicle value Max all-In LTV up to 130 00% Max Maintenance Sale Price not to exceed 52000 00 Bureau Information Experian htlps://www.dealertrack.com/FN 14/PrintBarCode/print_app_details.aspx?BarcodeTe.xt=1 .. 12/12/2016 EFTA00124047 Object 006E63WJ (Page 3 of 18) Page 2 of 2 Use invoice or trade-in value for book value. Kelly Blue Book limited to AZ, CA, CO, ID, MT. NM. NV. OR, UT, WA and WY. All approvals are subject to verification. Contract purchase is subject to satisfaction of stipulations and receipt of all required documentation as specified in Capital One Auto Finance program guidelines. All deals must be received and funded within 30 days from the date of the original Approval. Analyst Information tor App ID 129939171 Re!abonshp Manager. Borislay Tabak Fundm: Mane! er. Malthew Paella hups://mvw.clealertrack com/FN14/PrintnarCode/print_app_details.aspx?BarcodeText- 1 12/12/2016 EFTA00124048 ii n It ir 1 I !lap H i n t ' ll i i! I h i ' Ritri islitffillitlit IIi is • tg, I F as, = mitt l ift 3 i. it 111 t 3; hi :wily It I! /lidl: 1 INio I Minh; I I 1. ii Is as 1711:11 lti E i• in ill ! 11: "" Jitill ll!' !III I I hi IL h!u bi iii; Motif qui' ill ! i ill t it id 'O H it ih fp° 1I kith 1 i ;If. J NI I dr1 qt r; i I thd li li it 84 t it e , II if III IP, \' ti- k" i I illi fi. IN Pl Or It (Rim cp h dui 1 1i Iltish- L'i kJ is i's iii fi In q i t - a! ti N i 1 A iu \ • • I i 1 I i i t RI d'iltiild 11,4i qh.I *till il . I Di I gig. i 01 film ill ift ihi qi 2 sti ja I it lit: „ lb . 1 1, ittim • il legit itiliptit thiiipll ; i 1 i l l I; . it ll 8 P g l 1 h 1 II ; 0 Ls) ;1 i th: gr inn lifts ; g= Iii 1 i II EFTA00124049 Object 006E63WJ (Page 5 of 18) MIMI roomer •01itaillat .1.00 0.10.4.000.0.111 • No a. eV ape Pea Sap eV .. 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CUM SO MIS MICH TIN a COWS MOW SNOT 111* MUM Of 00000 M SIIIMOIS OMB= PS 101170. WTOTIC•MOCOMIIICINORICOOVUNNEOMPOIARYThe DEMI MOLL NOT OWIONSIWITS MOON TIN 02•10010Ittlebt rOf IMO For* cami. Ms r et eve I WWI F easion iaY.MpYW NYNa•01 lame v Olbea.NMa WitibI W hi* eon, we &Stew Woe ire moans of muse. , ••••••••10••••••• •. %PM. MP et EFTA00124050 Object 006E63WJ (Page 6 of 18) - • • Dear Name MAJOR WORLD CHEVROLET LLC PLEASE PRINT -INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. INSTRUC DONS: You Trey aptly for COX inyos Tway acts, TROTS a Kt you toenstiried () &ate otkcievinfier you to SOWN 10' Clirdiktalateft O 104 Credo CI Commit/ experty Stale O Bus-nessiccicabcri Mall few ti* weryng fir adodal cad, - yew nava ind trig on you own incomecc assets and ial The nacos ce otters cr more personas Me bass el spay sr a Sieged rectum* etc:Otter:sty SCOKOA (310 If you tic aradyrigk' tortoni mlhenather pax& etatluestestrna anal we wiero ONVor forieslotat taken CO(Piamt meaty alatspleak carplaeSedianAtibeiiyourseit andSecksi a abed yax tome You Milo r Ms accnanon Wurexuse ”I youaremarreiwdive ire Ste MS son fis aptkaionorty liftwants-00N 6 AARPLIC T4NFORMATION7-: ,.. :. ,i Zki:A... . :.'r.:: ern Zir.??•,:zitsdke.",...:i i.,., ....;SAVV),.P:: .e.' . t.":;., Last Mame Find tone shwa ins Scoot Sea INM 11 OM Apt it ?Sulu ril PO gee RitaiRiale CIty Sale BROOKLYN I NY Zip 11234 Norm Mow ' Oa Pore' Renowned Stela a) siarreerrner O Rein O Fan* O Ogee In Saddler 8 yrt, Not Regalia. Pal 1 500.00 two Address Clovers License NO Carvers License Nate Tomcat Ponta Address Prniors i us saws tt ins Iran 2Yeers1 Au x !Segel PO as Rol Ross ON Saxe Zv Emplwer Name NY STATE ASSEMBLY Emsloyirent 0 Erroored lype O 'nonaciyee O Sellemeloyed O Mribirr Relied O SLUM O ohs Salary 79,500.00 Saar/Type O 'A m* O &Weekly O Montt* CI ay Amway Occupation lard:not Ensecyrres Pin • ASSEMBLER I 2 Yrs 5 mos. Maus &twofer Name lafewataEmptOyment O Emeltried Type O Linernoloyed O Sell-enOoyed O Mblary O Reuss O start O 0" Previous Oatcake. Lear at ErnalOyellent Yrs. Moe Premed, Work Preeersureer AS mosaltd rut ml Coles ircore (WINO Sot/etiolates Worm • lI !-ANac*Liri aaotriteki:, • • • • • •• •-••• comments AGREEMENT You understand and agree that you are applying br credit by provkleg the intern abort to complete and submit this credit applcabon. We nay keep ths apish:anon and any otter appscaton Subrrilted to us arid Information about you tstetner or not tne application ts approved You candy that the nformation on the appicason ark in any other applicaton submitted to us, is Ina and completer. You urderstard tel false statements may subject you to canna' penalties The words 'you." 'your and 'yours mean oath person submitting this applkadort The words nem." "us,""our and 'ours' as used below rater to us. the dealer, and to the Inar.cial instdulbon(s) seleeted to receive your acplicatica. You authoree us to submit this apploabon and arty other application subm tted in connection with trio proposed transaction to tne financial institutions disclosed to you by us the dealers, in addlion, in accordance with the Fair Credit Reporting Act. you 'laborers that such financial institutions may submit you applications to odor financial insettelens for Vie purpose of failing your request to apply be credit Tnis apply:aeon wll be reviewed by such financial institutions on behalf of Meniselves and us the dealer. You agree that we may obtain a consumer credit report periodically from one or more consumer mooning agonoes Well bureaus) P connection with the proposed transaction and any update. renewal, reinancing. modification or extension of that transaction. You also agree that we or any anal* of ours may obtain one or more consumer credit reports on you 31 any time whatsoever. If you ask you win be told whether a credit report was requested, and i so, the name arid address or any credit bureau from whch we or our affiliate obtained your credit report You agree that we may verify you erripleyrnenl, pay. assets and debts, and that anyone receiving a copy of this is authorized to provide us with such nformation You Further authorize us to gather whatever credit and empOyment history we consider necessary and appropnale in evaluating Ins application and any other applications subnitheri in correction wan the proposed transaction. You understand that we will rety on the information in this credit application in making our deosion We nay monitor and record telephone calls regenlig your account for quality assurance, compliarco, training. or similar purposes You content to receive autoclakd. prerecorded and anise' loose calls and text messages low servicing and cOkctiOn purposes horn vs at the telephone nUnlber1S) provided in the credit application, including any cell phone numbers. The consent applies to the dealer, who is the originating cadger in this transaction, as we d as any assignee who may purchase your croft contract You agree that this Consent applies regardless of whether you agree to receive tetemaricetingrsves calls and text messages as provided below. I consent to receive au todialed, pre-recorded and artilidal voice telemarketing and sates calls and text messages from or on behalf of dealer (or any financing source to which dealer assigns my contract) at the telephone number(s) provided In this credit application, including any cell phone numbers. I understand that this consent Is not a condition of purchase or credit. Dealer Phone fr 718.937.3700 Dealer Fail 7 • 7 - Initial to consent here anwaetin nor W farirate .310.49 'pond/ Insiteorts tha.ra(e ardAe:nweee: . . YOU MAW PEIOANO AGREE TO THE TERMS RNOorsqLosURES OtitINEi PAGES OF POS:ARRUEETTON lala. 1(0 DATE VI Stly o, • in i7m sate. IA Pm EFTA00124051 Object 006E63WJ (Page 7 of 18) a FEDERAL NOTICES IMPORTANT iNFORMAT ION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT If applicable to your credit transaction, to help the government fight the furdng of terrorism and money leurdenna attivrbess Federal taw regimes financial inStilutkinslci rattail verify. and record int:emotion trial klentifies each person who opens an account Wtialth4 means for you: When you open an accourt you hie be asked for your name. address. date of birth, and Ober information to identify you. You may also be asked to see you; driver's license or ether identifying documents. STATE NOTICES California Residents: An applicant, if married, may apply for a separate account. Maine and Tennessee Residents: You must have physical damage insurance covering ,osa or damage to the vehicle for the term of the carted For a tease. you must also have the liability insurance as deserted in the lease You may purchase required insurance through any insurance agent or broker and from any insurance company that * reasonably acceptable to us. You are not requimd to deal with arty of our affiliates when choosing an agent broker or insurer Your choice of a particular insurance agent. broker or 'rowel will net affect our credit decision, so long at the assurance provides adequate coverage with an insurer who meets our reasonable requirements. New Hampshire Residents: If you are applying for a balloon payment contract. you are entitled, if you ask, lo receive a written estimate of the moat* payment amount for refinancing tko balloon payment in accord with the creditor's existing refinance programs You would be cradled to receive the estimate before you enter into a balloon payment contract A balloon cOntrect Is an installment sales contract with a final scheduled payment that e al 'teal lw,ce the amount of ono of the eaner scheduled equal periodic installment payments New York Residents: In connection with yetiapplication for credit a consumer report may be obtained from a consumer reporting agency (crew bureau) If credit is extended, the party or panics extending credit or baking such credit may order additional consumer reports in connection with any update renewal or extension of the credit, If you ask. you will be told whether a consumer moon was requested and, if so. the name and address of any consumer reporting agency (credit bureau) from which such credit report was obtained Ohio Residents: Ohio lows against dscrirnination require that all cheddars make erectl equally available to all creditworthy customers and that credit reporting agencies maintain separate credit ketones on each Min:fuel upon request The Otto Civil Rights Commission administer') compliance with 1Ns law Rhode Island Residents. Consumer reports may be requested in connector, with this application. Buyer has the rigM of free choice in seleceng an insurer to provide insurarte required In cennacton with this transactor sitiect 10 min reasonable approval in accordance with appaca bile law. Vermont Residents: You audience us and any financial insbtution with which this credt application is shared. and each of their respective employees or agents, to obtain and verily inf.:mat/on about you (including one or more credit reports. nformahon about your employment and banking and tted1 relationships) that they may deem necessary or appropriate tn evaluating your credit a ppbcabon. If your credit application is approved and credit is granted you also authome the parties granting credit or holding your account. and their respedive employees and agents, to obtain additional erode reports and other information about you in connection with reviewing the account, increasing the available credit on the account (if applicable). taking colection on the accourd, or for any other legitimate purpose. Married Wisconsin Residents: No provaion of any marital property agreement, any wilateral statement trader We. Slat § 766.59 or any court decree under § 766.70 applied to marital property adversely affects our interest unless you furnish a con of the agreement. statement. or court decree or we have actual knowledge of such adverse provision before credit *granted If you are making !Ns credit application •rdiividually and not pinny with your SDOUSC, complete Section A about yourself and Section B about your nonappticant spouse. You nooapplicant spouse should net sign the Credit application if you are applying for Individual credit C3;11 'a] 020100t4 ‘, 1 In: Mr e're'tYtl•Cl. OT ant Pitilsd i 12/12120111•201.1411/ EFTA00124052 Object 006E63WJ (Page 8 of 18) • 'thiiiZioii4eas 6 onion oiiiii use ONLY . .DEALER SECTION 'r-, ‘1iii,.-;;;;., , Neer u MN Used wpm. Toe WeaLp 25000 w•oclut Type Retad 70O4 Naeta, Some I cenma P.. O,,,,td 0 lea' 2015 Mn. JEEP Model WRANGLER UNLIMITED Torn WV 4WD 4DR SPORT Term 72 Cash &deg Pea 25,030 00 Sas Tax 2,218 00 T & L Cairn Deem 174.00 6,000.00 Pore End Feetebats M. Trade Add Fee I Unpai 21 39Z00 d &swim AccdendrItethed Oval Lie Insured:a Gap Sena Pan I liacbraJfeas Ea. Ars Finn:el 21,392 00 " Th, 4 vthak 29.775 00 Nycoesel•Seue• NADA _ Raw value Rom Source Steeled Pi/1MM Redeemed APR Vett* 8ockat CI BOCIal Date Lerida Megrim Vends Goons " 4"•747, ,......;), c•;••••:rtir": k.F41:;WiZST<i;;; Ict, .. irirc:73117‘,F+:777ci ("134•14:4- " :4 xtir.-.7. .„.t. _ ,LL 'sel;• ..!altift.Q.: ).47S.*ar:;;;.... .L.-•,,.. i.N.a..„ Yodel TS, Month/ Payment Pep 3613 C 2014 Otshicui, ut MiitPO restensl DT Sad Panne. :V12•SI4st35.14 ry EFTA00124053 Object 006E63WJ (Page 9 of 18) c - Major World Chevrolet, L.L.C. 43.40:40fitiern Blvd.- Long IHAMI City, NY 11101 .m8)937-3700 alma, tvaLw. ALPHONSO CLARK. SOLD TO SERGIO AMESTEGUI AWrIESS: BROOKLYN, NY 11234 SEPIA:a-ANT NO OPTIONAL EQUIPMENT AND ACCESSORIES goiwiwor47tom STOCK NO PRICE OE CAP w N UC 13482.8 met:: 12/12/16 2 2 0 A Inspect ion UCBl6E4 TITLE 308 • DEALER SPECS 9 0 5 SALES MX 3 2 4 TOTAL CASH PRICE 12 N/A 0.00 N/A 0.00 ' 37.00 88.75 70.00 2, 18.76 27, 414.50 PETTITd!€1 CAPITAL ONE AUTO FINANCE meow • IMPORTANT.'NOTICE TQUSED CAR BUYER • (a) STATE LAW REQUIRES THAT SELLEPS 4,4441 ON CUYEM OF HAND CARS CERTIFY IN WRITING TO THE BUYER THAT EACH CAR'S 41 USED cAlli ;SAFE, CONDITION ATTI4E TIME OF SALE. EN THIS CERTIFICATION IS A GUARANTEE THAT TYPE .:THE CAEHS IN .SAFECONDITION AT THE TIME OF SALE. (c1 BUYER HAS A RIGHT TO aee • REQUEST TkI.E DEALER TO.REPAIR OR TO PAY IN FULL FOR REPAIRS OR ANY UNSAFE CONDITION INTHE CAA; WHICH DOES NOT COMPLY WITH THIS CERTIFICATION. RR S EUSINESOS LICENSED BY - HE DEPARTMENT OF CONSUMER AFFAIRS, 42 BROADW Y. • N.Y.: N.Y 10004 COMPLAINT PHONE DIAL. d41 r Y C.. D C A ND. 20040 7 5 @ 7DeaSeeppeuesi tee sozproceanq applicaecn fit regimaon and cam:kale 01 etle. and tar secu no 44:iml'or etsunciive,plekattapplicateeL THIS IS NOT A OW FEE 175.00: TEES VEHICLE.RECEIVED IN GOOD CONDITION: • S 4.2 D' :2 2 0 D .;240 N/A E. 000. 00 N/A N/A • . 2 0 5 — 351.27 24, 414.50 .!•mmetiONICNKE EE PORMIOXSSA/o eetucatoN Poe secesteanom woo MR OW-ATE OF intr. Ale !OP StANN2 "anima:. COW, nuasIMININal lag As:•UC4:10•41.11001Wel Kr 'MCC NANMINFI Mn SPLOS. OWE PROMPAM • CC CO tYANMAan NO! K -ft •ZoRr. umKNIA YEN mr-PC MCCSOIR TIE MAUR nit) rollbUtNIATIS. MOMS( WNW "ION WM AMU 410$ 00Q ater4".MIN.COR CEANICAN nA o' .00 C*s.. OST"Cr. AT. IC". • ; C:frIS NSTOP431101.:50,4STSiE::AS liky ItIO'CR AMIE i'..41:11fra..00•EWEZ FELLS CERIFESPIAT h€EXERE.:904- ItIODNOMEMERFARTORENDER,UNDER. : E.•;,•;: • -.1 • - - • N•ripcalt *WS ACt5.4 Or. . .1 . . . • . • . • EFTA00124054 Object 006E63WJ (Page 10 of 18) EFTA00124055 Object 006E63WJ (Page 11 of 18) Region: Vehicle Description: MSRP: NADA Official Used Car Guide Monday, December 12, 2016 Vehicle Summary NADA Values Eastern • December 2016 Stock #: 2015 7EEP Wrangler Utility 4D Unlimited Sport 4WD V6 VIN: $26,395 Weight: 4,075 Mileage: 24,009 Rough Trade-In Average Trade-In Clean Trade-In Clean Loan Clean Retail Base Value $25,975 $27,475 $28,700 $25,850 $31,050 Optional Equipment faced R.-rang Boards $50 $50 $50 $50 $75 Luggage Rack $50 $50 $50 $50 $75 Towing/Camper Pkg $350 $350 $350 $350 $400 Option Tots $450 $450 $450 $450 $550 Mileage Adjustment $625 $625 $625 $625 $625 Total NADA offidal Used Car Guide Values $27,050 $28,550 $29,775 $26,925 $32,225 I.0 PM VIIaJ MIMCIPMet IIMIltfitt no rcrimontibility or 'Walla) for any mon or minion,. or My rovitioosor additidom Ina& anyoac on thn prom A11,440:I roorimud a pCilibtittal or In. Powa Md Asscosare.. coorirld NIG .ID l'oo‘t and Ammoniac, EFTA00124056 Object 006E63WJ (Page 12 of 18) MV-82 tr elicae Department of '- ^"m" va. Motor Vehicles VEHICLE REGISTRATION/TITLE APPLICATION This tam is available et vi ow.dmicny.goy Belch Fs NO. O OAR b Actively r3 Renew) O Lease Buyout ❑Oup 0 MONIS VIELA 0 Rata WIER CI SONS Tax with Tee Oa I L on el Nero 1 VII Os. ea; i i En off I q. k. f f alai HeRil Cbc. i l l • l i l l Ciao I I t a spool ,-nywate AT 59 CF CO CP ea O. FA IP ' NO NE RE NR NU 00 OP OV PA PC PR RC RE 5.e. SO SR 3$ ST TE IL TO TP TR TX XR XS WO 4.0a vicfr s:Li4F?tIs k Seks TRe Sion VOA I Aytcicleet Rob Dates sees id. ITI Y. 0D:' .... IXl VIII ism Volts it. ma ewe', 0 Yes 0 we Pets hueber Tae Das PASS Dale Temp ad racily Oxus SR Is Re,: u lenecioeFT Spres Din Ties'. set the Werrevion in Omer ORS el. sekta INSTRUCTIONS.. ii COMPLETE 8 1000 , 814109 . WHEN 11 Amo EIAPPLY. COMPLETt THOSE SECTIONS. F'RINT CLEARLY IN BLU£ OR MACK INK. 0 STARK THE BOX Of THE TYPE OF SERVICE YOU NEED. (Pm mom Wormation. refer to tom MY-82 L liopistenngThrang a Vehicle a Flew York SOY/ rl Get a TITLE ONLY a I On O A FIRST REGISTRATION err an vale* 0 CHANGE a We gala log/ O REGISTER a cellCia S'S filgisTereci bola* noir vevcie ...Mr Mare meanie Warts oislaw, able the PLATE NUMBER On O ROMA Regatta's') O CHANGE a ReoistnXion Rohl Ion) a REPLACE DTI negislrelesn pleTS I-I TRANSFER • Rate HOU( O PleChelel my LEASED VEHICLE 1(01.I can upate the sauiess yes., legal:Mot Scrl rentw your nawIntiOn miline al eamEggwaggy. NAME OP PRIMARY REGISTRANT(LAD. Scat Meow NYS Slog Ikons* number of PRIMARY SEX DATE OF BIRTH SI NAME Of CO-REGISTRANT (Last Test Middle NYS *Ms Noma* mete of CO-REGISTRANT SEX' DATE or wpm [ L II; on . r 1,16 OFF Y" LI I I LI I I DAY TELEPHONE ' LNG War MOMS CHANG" tan f bra a Raponiam llo de 901 °Leased r , onso....... 0 TES ONO Kann* or 0 TVs CI No - - . ., ow. Nevi oltruno velfor Di OLoased QuL&S THE ADDRESS WHERE PLEA/IRV REGISTRANTGETS MAIL Pecute&mm Aare in Nam Reof 00 007 el bat nun* The maws leg be C. ow inewasno L.,......_ til A Ho Ciao rope BROOKLYN wail Sp Cade 11234-00 Cats of liewee7 TM ADDRESS WHERE PRIMARY REGISTRANT RESIDES F DI; f ERENT FROM THE MAJUNG ADDRESS NOT ems .P.O .KINGS L 04 4 Ma /04.0 . TOOT 1 ZOOM. DRIVER UCENSE NUMBER Of OWNER Ma owner of the vehicle must sign this section. ip 2 3 0 9 ci 4 p L I I 1 I 1 i NOTE: Do not complete this section if a completed Registration Authorization (form MV-95) Is 7 of attached or if you apply to renew a vehicle registration and the owner that has not NAME OF CURRENT OWNER mu. Feu WON "anged.R.C*1 of °*"h1" and MIS of 4".v"u(SrA"" °I bdhDARTTIEta, E NUMBER OF DATE OF BIRTH OVIIMIONional) [ - Sr& I DIE ADDRESS WHERE OWNER GETS MAE Ma naranrern E sop - "- ig50..yN 6111.1 4 1234 caltINGS AMPUTATION: The Velma. deserted n 9 • 'Winds/FR IO MSS, ISO FIORTIT SFFFFRIIs & 0 ousel. Mown ce ...avow ono. rif olrokoe of cmr..mormommAI IDeal VEHICLE IDENTIFICATION NUMBER VEHICLE DES Typo CRIPTOR Body for Can (mare One) I rig srkEp SlaralVeSona 0 2.0.044.0t Dcw, — ....... 8°4Y. TYP° f°r a poor EltkPlfeh akevs-RA at k ir arab/ Claw Caw Ira 0A as,. Dote* DElseek ORm OCHE OPmpEno 0 Niel _ . farta.b", V 4."FmtV ve',FMT Fainvi wit: .. Orgill. ODOMETER etc.* S 4 or 7 i1/4 100.11.11010Wnhor. r _1 ,.......,0,0n,,,e,„. 6 ) n„ W , i 24, 104 "`""fs' ftivt'n• (hones'. cis OM AVM Overee i . lA Cede 64660 WI wren.* Ices "as CAPITAL ONt. AU It FINANCE N Addiese P. R. BOX 660068 SACRAMENTO, CA 95666 - frt;.4% etnIl I I I I I I I i rat lien l.en tisaine I I I , I I I I Lema we Prey Subswes fuw:plit APP.." WI . *woo- e. _ . non itiameamlOanamlip) Oale I Mw-0/II 151 EFTA00124057 Object 006E63WJ (Page 13 of 18) g CHANGES. Wine ggly information about a current registration a title on page 1 of dos tom (for more iniermatiOni leaf to form AN-821. -Regisrennifilling a Vehicle in New York State) NAME CHANGE Print the former name exactly eke the former name is prided on the current registration or Ole. I " ___J CHANGES: Describe any vehicle changes and the reasons for (he changes. I . .--.--CY ADDITIONAL VEHICLE INFORMATION —• sser- QUESTIONS 1.3 MUST BE COMPLETED. t. I certify that, to the best of of my knowledge. this vehicle 0 has been or 0 has not been wrecked, destroyed or damaged to such en extent thal the tore estimate. or actual cosy of parts and Ilan lo rebuild or reconstruct the ventee to the condition it was in before an accident. and for legal operation on the road or highways. is more than 75% of the remit value of the vehicle at the time of cossicheckIng the "has been" box means the vehicle must have an antitheft examination before being registered, and that the title issued will have the statement "Rebuilt Salvage" on a.) 2 is leis vehicle registered for your pasona' use? 0 Yes IN No it you marked -Yes". go to Me nen question (question 3) . If you marked "No", check any of these boxes that apply: 0 I his vehicle Is a passenger vehicle that will be used for awe with a driver and wil be operated in the following location(s): 0 New Yak City (NYC) 0 A junidiclion that is not NYC that regulates taxis • A jurisdiction that does not regulate taxis 0 ins vehicle is a passenger vehicle that k rented without a driver. • Thd vettiCle requires 'permit for commercial operation. ((Nark he box of the type of n pemil that was issued and vote the peen number on the Ire ) • NYS DOT Penne No. 0 Federal DOT Permit No. 0 The government owns this vehicle • This vehicle is used as (mark one) • an ambulance • an ambulant! 0 a hearse or Invalid coach If payment is received In Carry passengers. mark this box.O 0 This vehicles used exclusively as a hearse il payment is received to carry passengers. mark Ibis box.O 0 this vehicle Is a commercial tow thick with a gross vehicle weight rating of at least 6600 pounds. 0 This vehicle is used only as a farm vehicle. (roan MY-260F, Part I. most be attached) ll This vehicle is used only as en agriculteral truck. 0 Mrs veticte is subject to the Deportmeet of Transportalwe in l - ion requirements for the earners that transport passengers. (For mete MicitmatiOn, refer to form k1V-62.1P. 'Inspection RequireenwiMor Garners Transposing Passengers'.) 3 Has this intebele been modified to change its registration chase 0 Yes • No ries". explain • a This vehicle is a pick-up truck with an unladen weight that is a maximum el 5.500 pounds. This vehicle Is never used for commercial purposes and does net have severlosing on any past of It. I want (mark one). 0 Passenger Plates • Commercial Plates CERTIFICATION: The intonation I have given on this appicalion Is true to the best of my knowledge. I certify that the vehicle is folly equipped as ironed by the Vehicle and Traffic Law, and has passed the required New York State inspection within the past 12 months. or has qualified fora time extension (Form VS-1077) and vet be inspected within 10 days. I also certify that appropriate insurance coverage Is in effect, and that the vehicle will be Operated in accordance with the Vehicle and Trate° Law. If I sin applying for replacement registration items. I certify that the registration is not currently under suspension or revocation. If I have plates in a series reserved for a special gory, I certif only one see • (dates. N I am using a credit card for payment of any fees in con signature beldlYY thirds', Lep ilacredif yard. hint Nam re Name He. Sign Her Peel WM, e irecasieng for •coworaike. env y5w 'Pee: and tail Ptint Additional r Additional Signal Sign He Name Hare (Priv Noma MFNI el. flN iftWANW frte.‘ e Nene Y IMPORTANT: Making a false statement in any registration application or in any proof or statements in connection with it. or deceiving or substituting in connection with this application, is a misdemeanor under Settee) 392 of the Vehicle anti Traffic Law, and may also result in the revocation or suspension of the registratien pursuant to regulations established by the Commissioner. The Department makes no representation that it will issue a cerhficate ol title or hanslerable registration until the Commissioner is &stifled that the applicant is entitled to a certificate of title or transferable registration. and unlit al cinciimentation tenured to establish ownenhip of the vehicle is submitted and deemed to be satisfactory. Pending review of this application, neither the Commissioner of the Department of Motor Vehicles nor any of his or her employees. deputies or agents assumes any eability a responsibifity for repass perfoimed. improvements made or work done to the vehicle referencedin this application CREDfT CARD AUTHORIZATION IF CARDHOLDER IS NOT THE APPLICANT: pi, signature authorizes tu use tray credit card for payment of fees in connection wlh ins Application, And I undetsterel mat l must be present for this liansactee. Sign Here e iv.Sgn here e rte) Lien 409 Code 4Ancod wiCeaV) benholder Ne:nte Ma& g Address APR (WNW Mel Skean Karl le' 4,•1 ;re `Ace; I ion I ;lee Code (Assirod by OW) liennfOet Nana t.1.-whey .1/4 kIresS wientersed seep,' Ica (aunt) CeN! NY I)EALER CERTIFICATION: I certify that all nlormabon provided on this applemion is lee. I take responsibility for the integrity of the papers delivered to the Motor Vehicles eke. ova afleacrited Rei,:eiseesree‘ “442 it/l5) PAGE 2 OF 2 EFTA00124058 Object 006E63WJ (Page 14 of 18) .a ti EFTA00124059 Object 006E63WJ (Page 15 of 18) ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY CERTIFICATE OF INSURANCE Agent Number: 000731 Broker Manic: Jared Shulman Application No.: Name Of Insured. j. Address BROOKLYN NY 11234 Date of Certificate 12/13/2016 Policy Effective: 12/12/2016 until 06/13/2017 Description of the vehicle: 2015 JEEP JEEP WRANGLER The person or organization designated below is described in the policy as: Lien holder CA two. ONE PO BOX 255605 SACRAMENTO CA 95865 THE FOLLOWING COVERAGES AND LIMITS ARE IN FORCE ON THE ABOVE DESCRIBED VEHICLE AA Bodily Injury • 3100,00013300,000 B13 Property Damage 1100,000 SS Uninsured Mot Bodily S100,0005300,000 Injury CC Medical Payments $100,000 DI) Collision (Ded) 51,000 Deductible IIS Comprehensive With Full SIPCO Deductible Glass .11 Towing and Labor (Occ) 5125 UU Rental Reimbursement S50/day (Day) VA Personal Injury Protection 02 Deductible Plan VA I Personal Injury Protection SO Deductible (Ded) VB Additional Personal Injury VB03 Protection THE LOSS PAYABLE CLAUSE OF SUCH POLICY PROVIDES: "The company reserves the right to cancel such policy at any time as provided by its terms, but in such case the company shall notify the Lienholder when not less than ten days thereafter such cancellation shall be effective as to the interest of mid Lienholder therein and the company shall have the right, on like notice, to cancel this agreement." THE ADDITIONAL INTEREST ENDORSEMENT OF SUCH POLICY, IN PART, PROVIDES: "..such insurance as is afforded by the policy "for automobile liability insurance listcd...hercof applies also to the person or organization named as Additional Interested Party "As respects such...interest, no cancellation...and no endorsemcnt...advcrsely affecting such additional interest, shall be effective until ten (10) days following the mailing of EFTA00124060 Object 006E63WJ (Page 16 of 18) NEW YORK STATE INSURANCE IDENTIFICATION CARD Policy Number 743 At I STATE FIRE AND CAS INS Isa-,e S Andress of i$4;per JAAISIncY 5040 Northern SI Long Island City NY 11101 (718)530-1802 An autxtized NEW YORK insurer has issued en Owner's Policy of levity Insurance complying wth Antio 6 (Moto/ Vehicle Fmanctol SearrilyAct) of the NEW YORK Vence and Traffic taw to. BROOKLYN NY 11234 4 1[11111 4 Effective Date Exprabon Date 12/12/2016 02/10/2017 12 01 am 12 01 am INN act-an:able to obtain registration aver 45 days from elfeavo date I Apolcabie vain respect to the Intotteng Motor Veil:de 2016 JEEP Year Make Whole Identicakon Maher *REPLACEMENT VEHICLE* THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING. Are person who issues produces an ID card knowing that an Owners Policy of Insurance is not in effect may be committing a misdemeanor. In addition. a person who presents an ID card it insurance is not in effect may be coremilting a misdemeanor The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION. DMV WILL ONLY PROCESSA VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. FS-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD 743 ALLSTATE FIRE AND CAS INS Nee a Andress of issuer JaiAgency 60-30 Northern SI Long Island City NY 11101 (718)630.1802 An authorized NEW YORK insurer has issued an Cranial POP/ of Litany Insurance canoeing wth Article 6 (Motor Vac* Financial Security Acn ct the NEW YORK Vehicle and Traffic Law to: BRO 11234 Effective Date Exprabon Date 12/12/2016 42/1012017 12.01am 12.01 a m (Not aaeotabe to attain reastraton atter 45 OM" from &fauna love.) Macadam"' maw to the blowing Ikea Voltscia: 2015 JEEP Year Make Vehicle identincaLon Number *REPLACEMENT VEHICLE* I THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING My person who issues or produces an ID card knowing that an Owners Policy of insurance is not in effect may be committing a misdemeanor. In addition. a person who presents an ID card if insurance IS not In effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMVIMLL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPUkCED VEHICLE'S CURRENT REGISTRATION FS-20 FAX: Scanable Ba Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. N submitted to CMV. either the entire page or the second ID Card end large scanable bar code will be retained 3 A faxed ID card must be replaced with a scanable ID card within 14 days of the effective dale. 4. DMV will not accept a faxed ID card without scanable barcode EFTA00124061 Object 006E63WJ (Page 17 of 18) Major World Chevrolet Major World Chrysler Jeep Dodge Ram Major World MWC: DMV# 7117189! DCA# 2003442 (718) 937 3700 (718) 937 - 9770 Fax (718)786 - 8300 (718)786 8301 Fax (718) 937 - 4545 (718) 937 - 0562 Fax MWCDJR: DMV# 7118172 / DCA# 2012157 MW: DMV# 7117189 / DCA# 2003442 gas PERSONAL REFERENCE SHEET (MUST BE COMPLETED) BUYERS NAME: HOME PHONE #. REFERENCES: LANDLORD or MORTGAGE COMPANY NAME. ADDRESS. PHONE! NAME RELATIONSHIP: ADDRESS: PHONE: NAME' NAME: RELATIONSHIP: RELATIONSHIP: ADDRESS. ADDRESS: PHONE: PHONE: EFTA00124062 Object 006E63WJ (Page 18 of 18) Otte A7t4 F"C:Ka0 • .. • EFTA00124063