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►mss. <br />1.%10 <br />�p <br />40414 <br />.4iM• <br />.M <br />i.etsti• <br />�1�M• <br />iia <br />...5 <br />•d. <br />, . <br />►•EtA <br />41,47. <br />• 4. <br />411141.1 <br />-�'Nomt <br />NEBRASKA CERTIFICATE OF /TITLE IAA <br />. <br />11111111111111111111 HII II 1111011111 <br />VOA <br />Vehicle Identification NumberWrosirl <br />LPP9627 <br />Year Make / Model <br />1999 LINCOLN PARK MOBILE HOMES, INC /'DGATO7ODBF <br />Previous Document Body Style <br />Bill of Sale <br />Color <br />202100712 <br />MANUFACTURED HOME BLUE <br />Mail To <br />JESSICA A VALASEK <br />515 SATURN ST <br />ALDA NE 68810-9667 <br />Purchase Date Issue Date <br />28 -Aug -2009 24 -Nov -2020 <br />Residential Address <br />515 SATURN ST <br />ALDA NE 68810-9667 <br />Owner Name(s) <br />JESSICA A VALASEK <br />OR JUSTIN VALASEK WROS <br />SELLER MUST COMPLETE <br />PURCHASER'S INFORMATION <br />Federal and State law requires that the seller state the mileage in connection with the transfer of ownership. Failure to complete or 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 all 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 knowledge the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked: <br />ODOMETER READING <br />NO <br />TENTHS <br />CAUTION <br />READ CAREFULLY <br />BEFORE YOU <br />CHECK A BLOCK <br />❑ 1. The mileage stated is in excess of its mechanicalftmits. <br />❑ 2. The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY. <br />ALL OWNERS WHOSE NAMES APPEAR <br />ON THE FACE OF THIS TITLE MUST SIGN. <br />SIGNATURE OF SELLER <br />10. <br />SIGNATURE OF SELLER <br />SIGNATURE OF SELLER <br />PRINTED NAME OF SELLER (ONLY ONE PRINTED NAME REQUIRED) <br />DATE OF SALE <br />PRINTED NAME OF PURCHASER(S) <br />ADDRESS <br />I AM AWARE OF THE ODOMETER STATEMENTS <br />MADE BY THE SELLER(S) <br />SIGNATURE OF PURCHASER <br />SIGNATURE -OF PURCHASER <br />Title Number <br />001113431 <br />County Official <br />ALAINA VERPLANK <br />Y x•1.1!- _-..�•I•V- _'..1•pr- x•1.1!-: ,'>!.�,l ft:.!1:. �1 <br />r�����•P�r�l'1�t����1���1�1����t�1'1r����������������rNf�t�������,4�1����1 VOID IF ALTERED OR DUPLICATE ISSUED �1�w���q�ttOsystsyN��������� feststitA�•��������s��.�at��sl: <br />.• �.t.����1�1.1.1.�.-11A�1��1��. �.f,.t���1�1.1.�• l�.Lrrr,,-. .:.:40..:..• .fir :.. .:.yr�:...- .../�I�i���. tt�i�1�1N. �.1.I�I�i�� �Q��1�1.11. <br />REV. 07/2013 <br />