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Vehicle Identification Number <br />HA00657A13M0 <br />Purchase Date Issue Date <br />5/08/2013 10/27/2015 <br />¥ear Make <br />1999 COLT <br />Mode l <br />28X64 <br />Previous Title Number/State Title Type <br />AFFIDAVIT ORIGINAL <br />Body Style <br />MFGD HOI\AE <br />Color <br />G V W Capacity-== = - - - Odometer-, <br />- - <br />- - = <br />Owner Name(s) And Address Legertds <br />EXEMPT <br />JEREMY STRAATMANN <br />14375 S ALDA RD <br />WOOD RIVER, NE e8a83 - - - <br />LIEN RELEASES <br />1st Release <br />SELLER MAST COMPLETE <br />Federal and State law requires that the seller state the mileage in connection with the transfer of ownership.. Failure to or . o complete o providing a false statement may result in fines and/or <br />imprisonment. (RETAIN COPY FOR 5 YEARS.) <br />The undersigned, being the owner of the vehicle described within the Certificate of Title, hereby sells and assigns at right, title and interest in and to said Certificate of Title and the vehicle <br />described therein to the following named purchasers. <br />I certify to the best of my kilowtedge the odometer reading4s-the actual mileage of the vehicle unless one of the following statements . is checked: <br />El 1. The mileage stated is in excess of its mechanical 'knits. <br />o 2. The odometer reading i not the actual mileage. <br />ODOMETER READING <br />CAUTION <br />READ CAREFULLY <br />BEFORE YOU <br />CHECK A BLOCK <br />WARNING - ODOMETER DISCREPANCY. <br />ALL OWNERS WHOSE NAMES APPEAR <br />ON THE FACE OF THIS TITLE MUST SIGN. <br />SIGNATURE OF SELLER <br />SIGNATURE OF SELLER <br />PRINTED NAME OF SELLER (ONLY ONE PRINTED NAME REQUIRED) <br />INVENTORY CONTROL NUMBER <br />HALL <br />D 253913 7 lAiitness11411 fleadAnd Official Seal The Date ShowrtAbove <br />15300080108 <br />ookr.Mmattir ltito* .ffetilbt.lovirtititeitsfirt• INV* 14 <br />4:241 "NM " f t, NOWAVAGW6 ), ftt VOID IF ALTERED OR DUPLICATE ISSUE <br />- - -.4:4710 *AVOW ILVAINIANNS - <br />"NW <br />PURCHASEFI'S INFORMATION <br />PRINTED NAME OF PURCHASER(S) <br />STATE <br />I AM AWARE OF THE ODOMETER STATEMENTS <br />MADE BY THE SELLER(S) <br />SIGNATURE OF PURCHASER <br />201507330 <br />REV. 07/2010 <br />VTITLE1 V1R0 07082010 <br />