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LLLLMLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL: 11111111111 I LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLL
SALVAGE CERTIFICATE
For a 1973 or Newer Motor Vehicle
OTHER JURISDICTIONS: D
the vehicle ant.! its major c'
poses unless
~ss them.
VEHt:::LE DESCRIPTIOI'o. -
2.
VEHICLE CONDITION
1int pen.)
..
E Q1917 U
S ON PROOF OF OWNERSHIP
0 Rear Clip
0 Cowl
0 Nose
------------------~----~~------.
0 Driver
0 Passenger
0Engine
0Transmission
!;]Body
0Frame
LlNone
0 Other Specify
A;
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INSURANCE
CO. CODE
NO
INCLUDE EITHER AN APPRAISAL OR TWO PHOTOS OF VEHICLE FROM DIFFERENT ANGLES WITH DMV COPY (COPY 2) UNLESS VEHICLE IS STOLEN -NOT RECOVERED
4.
LIEN INFORMATION List all liens for which a lien satisfaction has not been received. If liens are subsequently satisfied, send form MV-901, Notice of
Recorded Lien, to person to whom the vehicle was transferred.
STATE
5.
ZIP CODE
STATE
ZIP CODE
VEHICLE DISPOSITION/ODOMETER DISCLOSURE REQUIREMENTS Federal and state law requires that you state the mileage upon transfer of ownership.
Failure to do so, or not telling the truth about mileage, may resL!It in fines and/or imprisonment. This form will be returned to you if this section is not completed.
CHECK ONE BOX:
I, the seller, certify that to the best of my knowledge, this vehicle's odometer reads as follows and (check the box which applies}:
,{] Reflects the Actual Mileage 0 Exceeds Mechanical Limits 0 Does Not Show the Actual Mileage -Warning: Odometer Discrepancy '----'--------'----'-"'-"---"'
PRINT NAME OF PURCHASER
PRINT NAME OF SELLER
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06/20/13
CO-OWNER'S SOUNDEX I DRIVER LICENSE NO.
975-0 02-293-074
NA~~E(S)
ODOMETER CODES
USAA IN SURANCE
A. Actual Mileage
B. Exceeds Mechanical Umits
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14149 B AN YWIN E ROA C
BP ANDYWI 'E
44118936
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CVRBRA13171019
M.J 2 0 613
Stock#: 11336864
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SALE D0 CL>
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THIS IS TO CERTIFY THAT A CERTIFICATION OF A TOTAL LOSS CLAIM HAS BEEN FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE
INSURER I INSURED SHOWN HEREON. THIS CERTIFICATE CONSTITUTES EVIDENCE OF OWNERSHIP IN LIEU OF THE CERTIFICATE OF TITLE, SURRENDERED
TO THE MOTOR VEHICLE ADMINISTRATION UPON ISSUANCE OF THIS DOCUMENT.
THE ADMINISTRATION WILL NOT BE RESPONSIBLE FOR FALSE OR FRAUDULENT ODOMETER STATEMENTS MADE IN THE ASSIGNMENT OF THE SALVAGE
CERTIFICATE OR FOR ERRORS MADE IN RECORDING BY THE ADMINISTRATION.
ISSUANCE OF THIS CERTIFICATE DOES NOT IMPLY THAT THE DESCRIBED VEHICLE COMPLIES
WITH FEDERAL, STATE OR LOCAL ENVIRONMENTAL CONTROL OR SAFETY STANDARDS.
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I, THE UNDERSIGNED AUTHORIZED REPRESENTATIVE OF THE POLICE AGENCY NAMED BELOW, HEREBY CERTIFY THAT, I HAVE INSPECTED THE VEHICLE
DESCRIBED ABOVE AND VERIFIED THE VEHICLE HAS BEEN RESTORED AND THE VEHICLE IDENTIFICATION NUMBER IS CORRECT
ID OR BADGE NUMBER
INSPECTION DATE
VR-1 08 (05-11 )
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NO LIENS
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ODOMETER READING
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t the odometer ding is the actual mileage of the vehicle unless one of the following statements is checked:
cess-6fiiSiil ch
tmits. 0 2. The odometer rea<;ling is not the actual mileage.
WARNING-ODOMETERDISCREPANCY.
Printed Name of Selle~{~ :::::--....-::o::,--,----------------1
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Pri~~~~ INI arne of Buyer(s) +'--"!'1 ~- - --:::.:--=:-::-----:-.;:--'-'-.:,....---...;-::--.--!
am aware of lh.e',EI.bove odomel~r C~rtification made by w~ Seller(s)
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Signature of Seller(s)
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Z-975-001-809-983
NAME(S) AND ADDRESS OF REGISTERED OWNER($)
ODOMETER CODES
A. Actual Mileage
CAri lEV
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<IAAI SLD 50677771 SALEDOCC>
DAMAGE
G~E~TR
THIS IS TO CERTIFY THAT A CERTIFICATION OF A TOTAL LOSS CLAIM HAS BEEN FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE
INSURER I INSURED SHOWN HEREON. THIS CERTIFICATE CONSTJTUTES EVIDENCE OF OWNERSHIP IN LIEU OF THE CERTIFICATE OF TITLE, SURRENDERED
TO THE MOTOR VEHICLE ADMIN ISTRATION UPON ISSUANCE OF THIS DOCUMENT
THE ADMINISTRATION WILL NOT BE RESPONSIBLE FOR FALSE OR FRAUDULENT ODOMETER STATEMENTS MADE IN THE ASSIGNMENT OF THE SALVAGE
CERTIFICATE OR FOR ERRORS MADE IN RECORDING BY THE ADMINISTRATION.
ISSUANCE OF THIS CERTIFICATE DOES NOT IMPLY THAT THE DESCRIBED VEHICLE COMPLIES
WlTH FEDERAL, STATE OR LOCAL ENVIRONMENTAL CONTROL OR SAFETY STANDARDS.
ID OR BADGE NUMBER
INSPECTION DATE
VR-108 (05-11 )
\6 ysq78dNonrepairable Certificate
95 4 93758
4T3BA3BB9CU030300
Vehicle Body
Vehicle Make
Model Yr
WG
TOYOTA
201 2
VA Ti t l e Rec e ived Fr o m:
THE TITLE TO THIS VEHICLE HAS BEEN RECEIVED
AND CANCELLED BY THE VA DEPARTMENT OF MOTOR
Vehicles on 0 1 /25/2013 due t o its being
NON - REPAIRABLE
296
CFOOll
VSA-0 (08/06)
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www . dm 't NOfl) . com
Virgin ia law requires you to notify DMV if you sell , trade or dispose of your vehicle or if you change your address .
I SOLDrfRADED/DISPOSED OF DATE
IN VIRGINIA
Mail this entire registration card to DMV, Attention : Data Integrity, P.O. Box 27412, Richmond , Virginia 23269-0001
If Your Are Changing Your Address- use one of the following methods to notify DMV.
- Visit the DMV web site at www.dmvNOW.com , select Address Change and complete the online transa ction .
- Vi sit the DMV website at www.dmvNOW.com , select Forms and Publications- form ISD-01 , Address Change Request
Complete form and send to DMV, Attention Data Integ rity, P.O. Box 27412 , Richmond Virginia 23269-0001.
-Call DMV at (804) 497-7100 and a customer service representative will assist you .
Afte r your address change request is processed , all DMV mail addressed to you , including vehicle registration renewa l
and driver's license renewal notices , will be sent to the new address .
If you change your residence/home address or mailing address to a non-Virginia address your driver's license
or your photo ID card may be cancelled.
DI/IIII/II/IIII/!~~!!DIIP~~IIll/11/IllDIIIII/I/DIII/I/HI
Stock# :
113459?~/~J:Je~,7s
SALE D 0 C A>
a l e Document
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Bltf of sale
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EDM@SfOIQJJe gocKb7tL ttO
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I, (name:)
3 19 kU
of (address: )
$0?5_2__, hereby certify that I am
' , ' . . , , I. .
,
/1/1 J
t~e la\.yfu,J
Year J.OOS
Make_ KT M
Model -50.c c
VIN#. .
Cj ))oQa2_:t'~h
Jlij
and have the authority to seli it. I hereby acknowledge th~ receipt of
$ 5' 0 0
. jn the form 'of CAS l-f . , from (Buyer's name:}
. .
: . . ':ps .full; paymentfor. ,t~e purchase of the said veh.icle,
. ,, ,
W~tth IS 6o1d A6 15 . J hereby state that the mileage oHhe vehicle at the time of
sale is
------
I do hereby grant, sell and transfer full ownership of this vehic~e to the buyer. I,
certify that this vehicle, at the .time of sale, is free from all encumbrances, taxes,
fees and liens except as those specified on the Title or Hsted below; and that, I
(~eller) will .defend and be h~ld fully respol")sible-for such lawful claims and
demands With respect to the vehiCle, if any. .
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Buyer accepts tun liability for the vehicle, damages, and ahy third party liability
incurred from the vehicle use from the date of sale. .
If applicable, Seller agrees to make arrangements for the re<:lsonable delivery of
vehicle title from lien hofdE;r to buyer immediat~ly .
'
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Date
Buyer's' Signature
Date
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