EFTA00310683.pdf

O FE0ISTRATIDI CIA: 121 Stp: 349 /SC: 01 Elf mate: 36/11/11 Thor/VIII: 13819K Nate: 6Ria ration Date: 06/11/2013 es Tax WM): 12148.00 re: 75.00 OW/001 e: CEO AIR 4.25 004/048 : CU AIR 5.75 OD4/016 : 3AFEll FLT 5.00 IITIV057 : TITLE ?3.00 1707/001 Ri5P.A0FEF. 10.00 009/014 : S1,9 TAX 769.33 0001009 VcC 'FICIAL slECTICUT 5-1*ATION TIFICATE VOID UNLESS VALIDATED HERE BY CONNECTICUT s te" — OWNER'S SEX MM O F / STATE I CT RESIDENT piES❑NO RESIDENT ADDRESS ff/DaTerent Ir m A(anng Addees . PC Sorts NOT accnrabic) (10 Code) r. / ‘i. " fi IF CO•OWNERSHIP n JOINT/OR Requires ONLY ONE rl COMMON/AND - Requires ALL L--I signature to transfer ownership '—' signatures to transfer ownership 2 Ji CO•CAVNERIT SEX ❑M 0 F CCnOWNER'S BIRTHDATE CO-OWNEWS LICENSE NO. OFT ID STATE I the tumor of five (S) or more vehicles that are registered in my name. ether ordrodualy or DYES INITIALS ma. (2)10o not haves's:ease to sell. repast. recycle. base of real motor wiled°. lE NORMAL COURSE OF OPERATION MOST FREQUENTLY LEAVES FROM, RETURNS TO OR REMAINS (For property lax ) vehelo Is leased) LESSEE OPERATOR LICENSE NO. CONNECTICUT LEASING LICENSE NO. umber and Street) (Geyer Teen) (State) (Zip Cody 1/4 Iil>. 113:2111 11:23Att 894.50 2.t 70,1- MANE MODEL NAME OR NO. " - ..- =.. ::c-I 0 1- t-; BODY STYLE MO. Set.. die) I+ b ow ,67/4318601 CBS t-tc;QQ- *0029* • R Mactiman of Two) ,,-‘ 1 COOMETF_R READING (ANeage) (p I) q -; D NEW U OR WED COMAE USE NEW BUSED 0 YES NO 1 IlF.W.3: TOTAL. 894.50 FOR E VEHICLE 8,74.50 Plastic Pit ) • 111 SEAT NO. STANDEES CARRY SCHOOL CHILDREN? K YES 0 NO COSA. CARRIERAIS DOT NO. (II engem" WT. RATING HAZARDOUS MATE RIA1 INTERSTATE COMMERCE TRAILERS Rear Ilghb Brakes IT I ❑YES NO BYES 0 NO • required. resridlled toothhoxi must be In accordance with CGS 14-252. cw mei GA". Lingth DATE M nhicle OF I Li., URRENT ER DATE OF LIEN SECOND IJEN-HOLDE f3trAny)". SEC60118 ;D:EN phiehiche puntaggags ,fisee(21) ) ADDRESS OF LEN-HOLDER ADDRESS OF SECOND UEN-HOLDER ( AUsATONeye/ INSURANCE COMPANY NAME (NN Agent) I _ AUTo OMOBILE INSU NCE POLICY NO. ,,_.--- PG- R t I ,.....\ / i S. NAME OF SELLERS/ (W2 Cfmnilt trade tan names) IET ---c1 2 -:ei epsiFINI 6 1 0 has i kr ) DATE VEHICLE PURCHASED op,. 0.003 i MLLE" I sawrs ADDRESS • G eAri .-q0 4T- ST. N\/ PURCHASE PRICE (Be or Sab 'spoked) r , c.-7- -1 . TAX Exempnoil IF TAX READ REVERSE SIDE OF THIS EXEMPTION IS FORM. SPECIFY CODE AND ANY CLAMED ADDITIONAL INFORMATION. CODE NO. EXEMPTION INFORMATION (II leased vehicle lessor lex number a ii S. DIALER IDENTIFICATION NUMBER OF TRADED-IN VEHICLE YEAR MAKE CT DEALER LIC. NO. CT SALES TAX PERMIT NO. gpApigAguoti TOTAL SALES PRICE TILLMAN ALLOWANCE NET SALES PRICE STATE TAX COLLECTED DEALER SIGNATURE X DATE SIGNED The undersigned can** that there are no bans on this vothcH motet those specified above, the inainince reward by Connecticut law is in *flog end era' be mantainecl ding Mis regetrabco tee doe CT Taxing AulhOgy lot ny registered In have It than Passenger the In B. OWNERS lo =HAR :‘ M, POHL oil property any vent* previously myfour names) Dee pad. other reitsbelion TOOTH a *Differed accord ace MI Menulacturees Maximum Gloss VaNcle Wephl RhIinp The Internist= provided to the Commis's:mei of Motor \Tacks herein if Sitferbed by me. the undersigned. under penalty of See sleeveletII accatence ugh the provisoes of Seneca 14-i ID and 53.4.151b of the General Slandos I undoestand that if I make a statementwlvcb I do not believe be True. TAM PIM b WNW Die Calumniator. I era to autoci to proseculiOn under the abovitnoesO laws / \‘,. ../. TATE A I Al—, A/i713 i4 V- C(..., DATE SIGNED CO-OWNER'S SIGNATURE ^1 i — X DATE SIGNED ' DMV OFFICE S ONLY , 4 new has - 75 - saw Ss ' IlE0 4-10 ..„....-.-r D ..).. N i lk - iv\,_. ) -7 ofr- C.C. -. , S.C. TY RE TRATON ' .) MARKER PLATE NO. CAA / N i litS......- al‘ PRi07 STATE ; 1:781 -3- temp. can. iron .-------• transfer .(claiiiieTh, ( . 6 EXPIRATION DATE TAX TOWN b cf O RESTRICTION CODE sub. mg. ortifeiiions tIll Into. eel/`/ TAXABLEaCE _ ..4 ix)/ Y PL. HIGHEST FEE PAID areca l -s--e) ;gmeaoind EFTA00310683