FOLDER CHECKLIST

Grand

YEAR : 06_MAKE: Veep MODEL : Cherokee LAST 6 OF VIN : 1621519

DATE ACQUIRED : ACQUIRED FROM :

PROOF OF PURCHASE ACQUIRED MILEAGE :

ODOMETER DISCLOSURE

le CASH
FINANCED GPS :

PURCHASER'S NAME :Kathryn Beers

CERTIFICATION OF POLLUTION DEVICES

WODOMETER DISCLOSURE AT SALE

MILEAGE AT SALE: Exempt

PROOF OF INSURANCE

BUYER'S GUIDE

TITLE BRANDED : YESINO DISCLOSED TO PURCHASER : YES/ NO

DATE SOLD AT RETAIL : 3/1/22

DATE TITLE APPLIED FOR : 31883

WAS TRANSFER DONE IN 30 DAYS :
O YES

NO , WAS CUSTOMER CHARGED LATE FEE ? IF SO , EXPLAIN :

ESTIMATED TITLE AND REGISTRATION FEES : $ 08

ACTUAL TITLE AND REGISTRATION FEES : $ 90.35

REFUND /UNDERCHARGE: $ 18:15
 VWWWWWWWWWWWWWWWWWWWWWWWWWWWWWTON MAWAWAOMI

011583
850 N COURTENAY PKWY
MERRITT ISLAND , FL 32953 63-1482 /0670
RELIABLE AUTO SALES
RAG 321-604-6716

DATE
PAY TO THE 3/15/22
ORDER OF $
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CNTY # AGY # SUB # RPT# THE
SEALOF STATE L#
OF 2540215
19 2 CPT 5860 T# 1616695453
STATE OF FLORIDA B# 1381573
AUDIT # TRUST S # 90245396
IN APPLICATION FOR VEHICLE /VESSEL
GOD WE
CERTIFICATE OF TITLE

TITLE NUMBER VEHICLE /VESSEL IDENTIFICATION # YR . MAKE MAKE or BODY VEHICLE COLOR WT/LENGTH GVWILOC
MANUFACTURER TYPE

145973530 1J4HR58N06C161519 2006 JEEP 4D 4600

AD BLI
DATE OF ISSUE TRANS VEHICLE USE HULL PROPULSION FUEL VESSEL WATER FL NUMBER AUTH
MO. DAY YEAR CODE MATERIAL TYPE DESTRUCTION

PRIVATE
03 10 22 OU
BIRTHDATE RESIDENT CNTY
SEX MO . DAY YEAR Y N ALIEN RES .#
Applicant/Owner's Name & Address
KATHRYN CRYSTAL BEERS F 05 31 80 X 19
418 S BREVARD AVE APT 2
1st OWNER FL /DL # OR 2nd OWNER FL /DL # OR
COCOA BEACH, FL 32931 F.E.I.D. # UNIT #

B620503806910

VOLUNTARY CONTRIBUTIONS
AGENCY TITLE FEE SALES TAX GRAND TOTAL
FEE

4.75 81.00 0.00 85.75

Action Requested : ORIG USED TITLE Brands :

RETAINED AS ELECTRONIC TITLE

PREV . STATE DATE ACQUIRED NEW USED ODOMETER / VESSEL MANUFACTURER ODOMETER
DECLARATION
CERTIFICATION
IA 03/01/2022 XX EXEMPT

LIEN INFORMATION DATE OF LIEN RECEIVED DATE FEID # OR FL / DL AND SEX AND DATE OF BIRTH DMV ACCOUNT #

NAME OF FIRST LIENHOLDER :

ADDRESS SALVAGE TYPE

SELLER INFORMATION
NAME OF SELLER , FLORIDA DEALER , OR OTHER PREVIOUS OWNER
RELIABLE AUTO SALES
ADDRESS
4657 S HWY 1 UNIT A
ROCKLEDGE , FL 32955
DEALER LICENSE NO .
VI11342481 CONSUMER OR SALES TAX EXEMPTION #

INDICATE TOTAL PURCHASE PRICE , INCLUDING ANY $

SALES TAX AND USE REPORT UNPAID BALANCE DUE SELLER , BANK OR OTHERS
TRANSFER OF TITLE O PURCHASER HOLDS VALID
IS EXEMPT FROM EXEMPTION CERTIFICATE INDICATE SALES OR USE TAX DUE AS PROVIDED BY CHAPTER $ 0.00
212 , FLORIDA STATUTES
FLORIDA SALES OR VEHICLE / VESSEL WILL BE
USE TAX FOR THE USED EXCLUSIVELY FOR RENTAL
REASON ( S ) CHECKED OTHER SELLING PRICE VERIFIED

APPLICANT CERTIFICATION
IW/ E HEREBY CERTIFY THAT THE VEHICLE /VESSEL TO BE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HIGHWAYS /WATERWAYS OF THIS STATE .
I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED .
I CERTIFY THAT THIS MOTOR VEHICLENESSEL WAS REPOSSESSED UPON DEFAULT OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION .
I/WE HEREBY CERTIFY THAT I/WE LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL, AND MAKE APPLICATION FOR TITLE . IF LIEN IS BEING RECORDED NOTICE IS HEREBY GIVEN THAT THERE IS AN
EXISTING WRITTEN LIEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY LIENHOLDER SHOWN ABOVE . I/WE FURTHER AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

Signature of Applicant/Owner Signature of Applicant/Co -Owner

HSMV82041 REVISED 02/06 SCAN CODE MVT

I UNDERSTAND THAT MY DRIVER LICENSE AND REGISTRATIONS WILL BE SUSPENDED IMMEDIATELY IF THE INSURER DENIES
THE INSURANCE INFORMATION SUBMITTED FOR THIS REGISTRATION .
 MTRFS020
IMPORTANT INFORMATION
Section 316.613 , Florida Statutes, requires every operator of a motor vehicle transporting
a child in a passenger car, van , autocycle or pickup truck registered in this state and
operated on the highways of this state, shall, if the child is 5 years of age or younger,
provide the protection of the child by properly using a crash - tested , federally approved child
restraint device. For children aged through 3 years, such restraint device must be a separate
5
carrier or a vehicle manufacturer's integrated child seat. For children aged 4 through 5 years,
a separate carrier, an integrated child seat, or a child booster seat may be used .
For limited exceptions, see s . 316.613 , F.S.

S. 320.0605 , F.S., requires the registration certificate, or true copy of a rental or lease
agreement, issued for any motor vehicle to be in the possession of the operator or carried in
the vehicle while the vehicle is being used or operated on roads of this state .

S. 320.02 and 627.733 , F.S. , requires personal injury protection and property damage
liability to be continuously maintained throughout the registration period. Failure to maintain
the mandatory coverage may result in the suspension of your driver license and registration .

Mail To :
KATHRYN CRYSTAL BEERS Important note : If you cancel the insurance for this vehicle ,
418 S BREVARD AVE APT 2 immediately return the license plate from this registration to a Florida
COCOA BEACH , FL 32931 driver license or tax collector office or mail it to : DHSMV, Return Tags,
2900 Apalachee Parkway, Tallahassee, FL 32399. Surrendering the plate
will prevent your driving privilege from being suspended .

CO /AGY 19/2 T # 1616695993

B# 1381573
FLORIDA VEHICLE REGISTRATION

PLATE 82KDU DECAL 17770291 Expires Midnight Tue 05/31/2022

N.
YR /MK 2006 / JEEP BODY 4D COLOR BLK Reg. Tax 1.60 Class Code 1
VIN 1J4HR58N06C161519 TITLE 145973530 Init. Reg . Tax Months 2
Plate Type ESR NET WT 4600 County Fee 3.00 Back Tax Mos
Mail Fee Credit Class 1
DL /FEID B620503806910 Sales Tax Credit Months 2
Date Issued 3/10/2022 Plate Issued 11/19/2021 TRANSFER : X Voluntary Fees
Grand Total 4.60

IMPORTANT INFORMATION
KATHRYN CRYSTAL BEERS 1. The Florida license plate must remain with the registrant upon sale of vehicle.
418 S BREVARD AVE APT 2 2. The registration must be delivered to a Tax Collector or Tag Agent for transfer to
COCOA BEACH , FL 32931 a replacement vehicle.
3. Your registration must be updated to your new address within 30 days of moving .
4. Registration renewals are the responsibility of the registrant and shall occur during
the 30 -day period prior to the expiration date shown on this registration . Renewal
notices are provided as a courtesy and are not required for renewal purposes.
5. I understand that my driver license and registrations will be suspended
immediately if the insurer denies the insurance information submitted
for this registration.

ESR - ENDLESS SUMMER

 BILL OF SALE /RETAIL INSTALLMENT CONTRACT
EXHIBIT: A

YEAR : MAKE : SALESMAN :

Ole Jeep C LAST 6 OF VIN : Cile - 519 Danny

NAME : D.O.B .:
5-31-80
Kathryn C. Beers

CURRENT ADDRESS : S. Brevard Ave. :

418 EMAIL_Kathn bisayahia.com
PHONE NUMBER : 654,200 1225
Cocoa Beach FL
32931

TAG STAUS ( CIRCLE ONE )

NEW TAG TURNED IN HAVE TAG NEED STICKER TAG TO TRANSFER :

82L Du
TAG EXP DATE :
os - 22
FULL SOCIAL : 153.76 3403

DOWN PAYMENT $ WEEKLY PAYMENT: $

***WEEKLY PAYMENTS ARE SUBJECT TO LOAN APPROVAL ***

FINANCE CONSUMERS ONLY

CURRENT EMPLOYMENT PHONE NUMBER :

ADDRESS :

od

INFORMATION PROVIDED IS DEEMED RELIABLE THAT WAS PROVIDED BY CONSUMER . CUSTOMER AGREES ANY CHANGES
REQUIRED TO COMPLETE THE TITLE TRANSACTION WILL BE BILLED TO THE CONSUMER . UNTIL PAYMENT IS RENDERED FOR
OUTSTANDING BALANCE, CONSUMER HEREBY AGREES FOR COMPANY TO LIEN TITLE ON BEHALF OF OUTSTANDING
BALANCE .

CONSUMER SIGNATURE : DATE :

Kathyn C. Burs 31/2027

PRINT:

Katthyn c. Beer
oo
 FLORIDA INSURANCE AFFIDAVIT

Under penalty of perjury , I KATHRYN CRYSTAL BEERS certify that I have

( Name of Insured )

Personal Injury Protection , Property Damage Liability, and , when required , Bodily Injury Liability

Insurance currently in effect with GEICO under

( Name of Insurance Company)

475412458 09170
covering the following motor vehicle :
( Policy Number) Company Code Number (5 digits )

2006 JEEP 1J4HR58N06C161519

Year Make Vehicle identification Number

This insurance company is licensed to issue insurance policies in Florida . I understand thatmy
driver license , license plate (s ) and registration ( s ) will be suspended effective from the registration
date , if the insurer denies that this policy is in force .

Signature of Insured
Kathryn

WARNING : GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE REGISTRATION

CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA LAW . ANYONE GIVING
FALSE INFORMATION ON THIS AFFIDAVIT IS SUBJECT TO PROSECUTION .

HSMV 83330 ( Rev. 09/09) www.flhsmv.gov

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 STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
Neil Kirkman Building - Tallahassee, FL 32399-0500
MOTOR VEHICLE TITLE REASSIGNMENT SUPPLEMENT

( Instructions on Reverse Side )

This reassignment is supplement to : Title No.: 20AA60395 State of Issue : lowa

Manufacturer's Statement or Certificate of Origin
Is the title electronic ? Yes X No
VEHICLE DESCRIPTION
Vehicle Identification Number Year Make Model Body

1J4HR5BNOVCI61519 2006 Jeep Grund

Cherokee
REASSIGNMENT INFORMATION
Name of Seller(s ) Agent (Print) DL / ID # , DMS ACCT#, FEID# DEALER / AUCTION LICENSE ( if applicable )
1ST STOP AUTO
DBA RELIABLE AUTO SALES VI
Street Address 4657 US HWY 1 UNIT A City State 1/34248 | Zip
]
ROCKLEDGE, FL 32955
Selling Price ( If Applicable) Sales Tax Collected (If Applicable ) Sales Tax Reg. No. ( If Applicable )
299.79 15. 8018 203551-3
Purchaser and Co - Purchaser's Printed Name(s) Date of Sale

Beers 3/1/22
Purchaser's Address City State
t Zip

418 S. Brevard Ave Cocoa Beach 32931

Co -Purchaser's Address ( If applicable) City State Zip

Auction Name (If applicable ) Auction License Number State of License Date of Auction

Street Address City State Zip

ODOMETER DISCLOSURE STATEMENT

WARNING : FEDERAL AND STATE LAW REQUIRE THAT YOU STATE THE ODOMETER MILEAGE IN CONNECTION WITH TRANSFER OF
OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND / OR IMPRISONMENT.

I /WE STATE THAT THIS 5 OR

6 DIGIT ODOMETER NOW READS, Rike XX
lupe, me tax( NO TENTHS)) MILES,,
DATE READ 3 1 22A
AND I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING
CAUTION : O 1. REFLECTS ACTUAL MILEAGE
READ CAREFULLY 2. IS IN EXCESS OF ITS MECHANICAL LIMITS
BEFORE YOU 03. IS NOT THE ACTUAL MILEAGE. WARNING - ODOMETER DISCREPANCY
CHECK A BOX

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING

DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE .
Printed Name of seller(s)/Agent Seller( Agent
s) Signature

Justin Ashness
Printed Name of Co - seller ( If applicable) Co -Setler Signature ( If applicable)

Am
Purchaser (s ) Signature Co -Purchaser( s ) Signature

Purchaser ( s) Printed Name First, Full Middle or Maiden , Last Co - Purchaser ( s ) Printed Name First, Full Middle or Maiden , Last

mike brodek ( PDA)

NOTICE : ANY ALTERATION OR ERASURE MAY VOID THIS ASSIGNMENT AND ALL ASSIGNMENTS THAT FOLLOW.

ORIGINAL : SUBMIT WITH APPLICATION FOR TITLE COPY: SELLER /DEALER RETAIN IN FILE

HSMV 82994 (REV . 04/14) S

 STATE OFTOWA
200DDDDDDD
Rise
CERTIFICATE OF TITLE TO A VEHICLE
Regular
Designation

Title No. 20AA60395 County Clarke Issue Date 11/08/2021

VIN 1J4HR58N06C161519
Type Multi -purpose
Year 2006 Make Jeep Model Grand Cherokee Limited 4W
Style
Cyl . 8 Fuel Gasoline Weight 4,600 GVWR
Color Black LP . $ 36,100 Sq . Ft.
Odometer Cumulative Damage

Owner( s )
Wasson , Tyler Brandon Fee Penalty
611 S Fillmore St
Title Fees $ 25.00 $ 0.00
Osceola IA 502131614
Fee for New Reg UT01
Registration Fees $ 84.00 $ 14.00
SI Fees $ 0.00
Prev . Title No./ST 776511190370042 / NC Plate Fees $ 0.00
Prev. Owner
Other Fees $ 0.00
Sherri Rene Wasson
Totals $ 109.00 $ 14.00
382 Mahogany Rock RD
Sparta NC 28675

1ST Security Interest If there are NO Security Interests " x " here : X
Date : No :
Held By :
Address:

Cancellation of 1ST Security Interest

Date No. Date
Holder CO Treas.
By By.

2ND Security Interest

Date : No :
Held By :
Address:
Cancellation of 2ND Security Interest
Date No_ Date
Holder CO Treas
By By

3RD Security Interest

Date : No :
Held By :
Address :

Cancellation of 3RD Security Interest

Date No. Date
Holder CO Treas.
By By

Witness My Hand

Jessica Smith By: Deputy

County Treasurer

Shaw
Shiny Hawlina
slawxby

THIS TITLE CONTAINS AN EAGLE WATERMARK WHICH IS VISIBLE WHEN HELD TO LIGHT
 Federal and State law requires that you state the mileage in connection with the transfer of ownership . Failure to complete or providing a fe se stete -mertime resulta
fines and / or imprisonment
ASSIGNMENT OF TITLE
The undersigned hereby certifies that the motor vehicle described in this title has been transferred to the following printed name and address
OF WESLEY CHAPEL
- MERCEDES - BENZ 2383 Willow Oak Dr. Wesley Chapel FL 33544
# further certify that the odometer reading is : 183120 and that to the best of my knowledge the odemeter neage is
ODOMETER READING
( No Tenths
actual mileage not actual mileage - WARNING ODOMETER DISCREPANCY exceeds mechanical das Female
DATE OFB 2 14 2021

1. Whave knowleoge the motor vehicle is now or was previously titled as salvage . rebuilt on food in this state or any other states res no
it les, and the frontof this title does not indicate that the vehicle was previously titled as salvage, rebuilt or food you must complete a separate damage discosure teren
give to the buyer.
2. If you answered " NO " to question # 1 . complete the following:
Whave knowledge that prior to or during the time owned the molar vehicle, it sustained damage for which the cost of tapar exceeded 70 % of the air make alle aus
damaged
Cres o No

Signature ( s) of Seller ( s)x 7

Printed Name of Seller * Tyler Wasson Jennifer L. Brownrigg
am aware of the above odometer gethalon made by the seller"
Agent CHAPEL
Signatures of Buyer's JB Printed Name's MERCEDES -BENZ OF WESLEY

FIRST RE -ASSIGNMENT BY LICENSED DEALER

ist Stop AutoDBA
The dersigned hereby certies that the motor vehicle described in this title has been transferred to the following printed name and address
ORLANDO
Island FL 32953
I further certify that the odometer reading is : EXEMPT and that to the best of my knowledge the odometer mileage is
ODOMETER READING
No Tenths
actual mileage not actual mileage . WARNING ODOMETER DISCREPANCY Lexceeds mechanical limits of Quongen 30 21
AUCTION DATE OF SALE 12

1. I have knowledge the motor vehicle is now or was previously titled as salvage , rebuilt or food in this state or any other state
Coro If Yes, and the front of this title does not indicate that the vehicle was previously titled as salvage, rebuik or flood , you must complete a separate garage disclosure saten entant
give to the buyer.
AUTO
2. If you answered " No " to question #1 , complete the following: AV
-
T have knowledge that prior to or during the time I owned the motor vehicle, it sustained damage for which the cost of repair exceeded 70 % of the fair market value before it became
damaged
AUTONATION Yes No
VF / 10887161
Wame of Dealer Dealer Na 18478111
MERCEDES - BENZ OF WESLEY CHAPEL
Signature of DealerRepresentative Kopi
IST STOP AUTO DBA Title
Printed Name of Dealer Representative Jennifer L. Brownrigg RELIABLE AUTO SALES
am aware of the above odometer certification made by the seller"
850 N COURTENAY PKWY
Signature ( s ) of Buyer(s ) Printed Names
Kvincent MERRITT ISLAND, FL 32953
Kateyencent
SECOND RE - ASSIGNMENT BY LICENSED DEALER
The undersigned hereby certifies that the motor vehicle described in this title has been transferred to the following printed name and address : 1ST STOP AUTO
DBA RELIABLE AUTO SALES
4657 US HWY 1 UNIT A
ROCKLEDGE, FL 32955
I further certify that the odometer reading is and that to the best of my knowledge the odometer mileage is.
Exempt
ODOMETER READING
( No Tenths )
actual mileage not actualmileage - WARNING ODOMETER DISCREPANCY exceeds mechanical limits of odometer DATE OF SALE
1/16/2

1. I have knowledge the motor vehicle is now or was previously titled as salvage , rebuilt or flood in this state or any other state , yes C No
If Yes, and the front ofthis title does not indicate that the vehicle was previously titled as salvage , rebuilt or flood you must complete a separate damage cusblosuite stanica
give to the buyer.
00-00-0 2. If you answered "No " to question # 1 , complete the following:
I have knowledge that,prior to or during the time I owned the modSE STOP AUTO DBA ine cost of repair exceeded 70% of the fairmarketvalle beforeit became
damaged
RELIABLE AUTO SALES
Yes I No 850 N COURTENAY PKWY
MERRITT ISLAND , FL 32953
Name of Dealer
Dealer No V11134248 / 2
Signature of Dealer Representative
fincent Title
Printed Name of Dealer Representative Bastio
1ST STOP AUTO
" I am aware of the above odometercation made Kvintent by the seller" DBA RELIABLE AUTO SALES
Signature ( s ) of Buyer ( s ) 4657 US HWY 1 UNIT A
Printed Name(s) Justin Ashness ROCKLEDGE, FL 32955
Any Alteration or Erasure Voids This Title
zu
 BILL OF SALE DATE : 3/01/2022 STOCK # : 10171
BUYER INFORMATION : SELLER INFORMATION :
FIRST STOP AUTO LLC
KATHRYN CRYSTAL BEERS
4657 US 1 UNIT A
418 S BREVARD AVE
COCOA BEACH , FL 32931 COUNTY : BREVARD ROCKLEDGE, FL 32955
HOME : CELL : 954-200-1225 WORK: 321-351-8444
D.L./STATE ID #: B620503806910 STATE : FL EXP. DATE : 5/31/30
D.O.B.: 05/31/80 SALESPERSON : DANNY
VEHICLE INFORMATION :
YEAR : 2006 COLOR 1 : BLACK VIN : 1J4HR58N06C161519 STOCK : 10171
MAKE : JEEP COLOR 2 : STYLE : LIMITED CYL : 8
MODEL : GRAND CHEROKEE BODY : 4DR MILEAGE : EXEMPT TRANS: AUTO
If this box is checked , the vehicle that you are purchasing has been licensed , registered, or used as a taxicab , police vehicle , or short- term - lease vehicle ,
is a vehicle that is rebuilt or assembled from parts , is a kit car, glider kit , replica, street rod, custom vehicle , has been repurchased by a manufacturer
under Florida's Lemon Law ( Fla . Stat. ch . 681 ) , or is a flood vehicle : ( indicate prior uses , brands or types )
TRADE -IN INFORMATION : SETTLEMENT
YEAR : COLOR :
MAKE : MILEAGE : VEHICLE PRICE 4,200.00
MODEL : BODY : 82.68
Predelivery Service Fee (see NOTE 1 ]
VIN :
SUBTOTAL 4,282.68
BALANCE OWED TO :
Sales Tax : 299.79
Title Fee : 88.50
BALANCE OWED : $ 0.00 GOOD THROUGH : License Fee : 0.00
ALLOWANCE: $ 0.00 QUOTED
Registration Fee : 0.00
Transfer Fee : 20.00
INSURANCE INFORMATION : 0.00
Temp Tag Fee :
COMPANY: GEICO
AGENT:
PHONE : POLICY # : 475412458 Payoff on Trade - in : N /A
LIEN HOLDER INFORMATION :
COMPANY :
STREET: ETR PROCESSING : 50.00
CITY , STATE , ZIP :

REMARKS :

TOTAL DUE 4,740.97

NOTE 1: This charge represents costs and profit to the dealer for items such as inspecting , TRADE - IN ALLOWANCE N /A
cleaning, and adjusting vehicles , and preparing documents related to the sale . CREDIT
WARRANTY DISCLAIMER : DEPOSIT N /A
Unless Seller provides a written warranty , or enters into a service DOWN PAYMENT 4,740.97
contract within 90 days from the date of this contract , this vehicle is
being sold " AS IS - WITH ALL FAULTS " and Seller makes no warranties,
express or implied , on the vehicle , and there will be no implied TOTAL CREDIT 4,740.97
warranties of merchantability or of fitness for a particular purpose .
This disclaimer does not affect any warranties by the vehicle manufacturer. Seller Cash Finance BALANCE DUE 0.00
neither assumes nor authorizes any other person to assume for it any liability in If financed, please see your installment sales contract for information
connection with the sale of the vehicle and the related products and services. about finance charge, insurance, and terms of payment ( other than cash ).
CONTRACTUAL DISCLOSURE STATEMENT ( USED VEHICLES ONLY) The info 'mation you see on the window form for this vehicle is part of this
contract. Information on the window form overrides any contrary provisions in the contract of sale . Spanish Translation : Guía para compradores
de vehículos usados . La información que ve en el formulario de la ventanilla para este vehículo forma parte del presente contrato . La información
del formulario de la ventanilla deja sin efecto toda disposición en contrario contenida en el contrato de venta .
Buyer hereby declares that they are of legal age to transact business and that no unfair inducementhas been made by Seller. This agreement
and the related documents that Buyer signs contemporaneously with this agreement, including any retail installment contract, contain the
entire agreement between Buyer and Seller and cancels and supersedes any prior agreement including oral agreements relating to the sale of
the motor vehicle . Any change to this agreement must be in writing and Seller must sign it .

X 3/01/22 Х N /A
Acéepted by Authorized Representative of Seller Date Buyer Bentoriza Co - Buyer Date
fachoel.
FZ - FLBOS rev . 05/21 © 2021 Frazer Computing , LLC
 Vehicle Air Pollution Control Statement

Florida Law prohibits the operation , sale , lease , or transfer of title of any automobile or light- duty truck
( 1975 or newer, 10,000 pounds gross vehicle weight or less ) that has been tampered with . " Tampering"
means the dismantling, removal , or rendering ineffective of any air pollution control device or system
which has been installed on the vehicle by the vehicle manufacturer except to replace such device or
system with a device or system equivalent in design and function to the part that was originally installed
on the motor vehicle ( 316.2935 , Florida Statutes).

As a motor vehicle dealer licensed to conduct business in the State of Florida, I hereby certify that the
following air pollution emission control devices and system of this vehicle, if installed by the vehicle
manufacturer or importer, have not been tampered with by me or by my agents , employees, or other
representatives . I also hereby certify that I or persons under my supervision have inspected this motor
vehicle and , based on said inspection , have determined that the air pollution control devices and systems
listed below , if installed by the vehicle manufacturer or importer, are in place and appear properly
connected and undamaged as determined by visual obser ration .

This certification shall not be deemed or construed as a warranty that any air pollution control device or
system of the vehicle is in functional condition , nor does the execution or delivery of this certification
create by itself grounds for a cause of action between the parties to this transaction .

MAKE : MODEL : BODY TYPE :

JEEP GRAND CHEROKEE 4DR
VIN : YEAR :
1J4HR58N06C161519 2006

Transferor's ( Seller's) Signature:

Transferor's ( Seller's ) Printed Name: / FIRST STOP AUTO LLC

Transferor's ( Seller's ) Street Address: 4657 US 1 UNIT A

City : ROCKLEDGE State : FL Zip Code: 32955

Date of Statement: 03/01/2022

Transferee's ( Buyer's) Signature :

Kathryn Bert
Transferee's (Buyer's) Printed Name : KATHRYN CRYSTAL BEERS

Transferee's ( Buyer's) Street Address: 418 S BREVARD AVE

City : COCOA BEACH State : FL Zip Code : 32931

1975 – 1980 Model Year : 1981 or Newer Model Year

Catalytic Converter Catalytic Converter

Fuel Inlet Restrictor Fuel Inlet Restrictor
Unvented Fuel Cap Unvented Fuel Cap
Exhaust Gas Recirculation System ( EGR)
Air Pump and / or Air Injection System ( AIS )
Fuel Evaporative Emissions System ( EVP )
10171
Stock No.
Form approved by the Department of Environmental Protection

HSMV 84058 ( 06/10 )

 STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
www.flhsmv.gov/offices/

SEPARATE ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT

VEHICLE DESCRIPTION
Vehicle Identification Number Year Make Color Body Title Number

1J4HR58N06C161519 2006 JEEP BLACK 4DR

ODOMETER DISCLOSURE STATEMENT

WARNING : Federal and State law requires that you state the mileage in connection with an application for a
Certificate of Title . Failure to complete or providing a false statement may result in fines and /or imprisonment .

WE STATE THAT THIS 5 or X 6 DIGIT ODOMETER NOWS READS EXE MPT XX ( NO TENTHS ) MILES ,
DATE READ 03 01 / 2022 , AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE THE
ODOMETER READING :
1. REFLECTS ACTUAL MILEAGE .
CAUTION :
Read carefully before 2. IS IN EXCESS OF ITS MECHANICAL LIMITS (EXCESS OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS )
checking a box .
3. IS NOT THE ACTUAL MILEAGE . WARNING - ODOMETER DISCREPANCY

UNDER PENALTIES OF PERJURYJ DECLARE THAT I HAVE READ THE FORE GOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE .
Seller's Signature Seller's Printed Name

Seller's Street Address Justin Ashress

Za
4657 US 1 UNIT A
City State Zip

ROCKLEDGE FL 32955

Buyer's Signature Buyer's Printed Name

Buyer's Street Beus

Kathryn C. Beers
418 S BREVARD AVE
City State Zip

COCOA BEACH FL 32931

WHO IS AUTHORIZED TO COMPLETE THIS FORM ?

ANY PERSON WHO IS BUYING OR SELLING A MOTOR VEHICLE AND WHO MUST MAKE OR ACKNOWLEDGE AN ODOMETER
DISCLOSURE , IN ORDER TO COMPLY WITH STATE OR FEDERAL ODOMETER DISCLOSURE LAW .
WHEN SHOULD THIS FORM BE USED ?
1 . WHEN A MOTOR VEHICLE , FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED , HAS BEEN SOLD .
2. WHEN A MOTOR VEHICLE , FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED , HAS BEEN PURCHASED .
3. WHEN AN ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT BETWEEN THE BUYER AND THE SELLER IS
REQUIRED , BUT NO ODOMETER DISCLOSURE STATEMENT HAS BEEN MADE ON ANOTHER STATE OR FEDERAL FORM .
WHEN SHOULD THIS FORM NOT BE USED ?
1. WHEN A FLORIDA TITLE WHICH WAS ISSUED ON OR AFTER APRIL 29 , 1990 IS AVAILABLE .
2. WHEN A FORM HSMV 82994 , MOTOR VEHICLE DEALER TITLE REASSIGNMENT SUPPLEMENT , HAS BEEN USED .
3. WHEN A FORM HSMV 82995 , MOTOR VEHICLE DEALER POWER OF ATTORNEY /ODOMETER DISCLOSURE , HAS BEEN USED .
4. WHEN AN OUT -OF - STATE TITLE , WHICH CONFORMS TO FEDERAL LAW , IS USED TO TRANSFER A MOTOR VEHICLE
FILING :
1. COPIES SHOULD BE EXCHANGED BETWEEN THE SELLER AND THE BUYER . DEALERS MUST RETAIN THIS DOCUMENT IN THEIR
RECORDS FOR A PERIOD OF FIVE YEARS .
2. IT IS NOT NECESSARY TO FILE THIS FORM OR ANY COPY OF THIS FORM WITH THE STATE OF FLORIDA , UNLESS REQUESTED TO
DO SO BY THE DIVISION OF MOTOR VEHICLES

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/

HSMV 82993 ( REV . 11/11 )

 ARBITRATION AGREEMENT

This Arbitration Agreement ( “ Agreement") significantly affects your rights in any dispute with us . Please read
this Agreement carefully before you sign it . This Agreement is governed by the Federal Arbitration Act , 9
U.S.C. SS 1 et seq .

In this Agreement, " you " and “ your” refer to the buyer signing below . “We ," " us , " and " our " mean the Seller , our
employees , agents , successors or assigns . “ Dispute " means any disagreement in contract, tort, statutory or
other claim or dispute between you and us arising out of or relating to your credit application , any retail
installment sales contract or any resulting transaction or relationship . “ Dispute " includes any claim or dispute
over the interpretation and scope of this Agreement.

EITHER YOU OR WE MAY CHOOSE TO HAVE ANY DISPUTE BETWEEN US DECIDED BY

ARBITRATION AND NOT IN COURT . IF A DISPUTE IS ARBITRATED , YOU WILL GIVE UP YOUR RIGHT
TO PARTICIPATE AS A CLASS REPRESENTATIVE OR CLASS MEMBER ON ANY CLASS CLAIM YOU
MAY HAVE AGAINST US . ANY DISPUTE IS TO BE ARBITRATED ON AN INDIVIDUAL BASIS AND NOT
AS A CLASS ACTION . YOU EXPRESSLY WAIVE ANY RIGHT YOU MAY HAVE TO ARBITRATE A
CLASS ACTION . THIS IS CALLED THE " CLASS ACTION WAIVER . "

Arbitration will be conducted by and under the rules of the American Arbitration Association (AAA )
(www.adr.org ), or any other arbitration organization you choose , subject to our approval. You may obtain AAA
rules by visiting the website .

Arbitrators will be attorneys or retired judges and must be selected pursuant to the applicable rules of the
chosen arbitration organization . The arbitrator shall apply governing substantive law and the applicable
statute of limitations . The arbitration hearing must be conducted in the federal district in which you reside , or
at some other location convenient to you . We will pay your filing, administration , service or case management
fee and any arbitrator or hearing fee all up to a maximum of $ 2,500 , unless applicable law or the rules of the
chosen arbitration organization require us to pay more . Each party will be responsible for its own attorney,
expert and other fees , unless otherwise awarded by the arbitrator under applicable law .

You retain the right to sue on an individual basis in small claims court for a Dispute within that court's
jurisdiction , unless such action is transferred , removed or appealed to a different court. Neither you nor we
waive the right to arbitrate by filing suit . We do not waive our right to arbitrate by seeking non - judicial recovery
of a vehicle .

The arbitrator's award is final and binding on all parties, subject to any right of appeal available under the
Federal Arbitration Act . Any court within jurisdiction may enter judgment on the arbitrator's award . This
Agreement shall survive any termination , payoff or assignment of the retail installment contract. If any part of
this Agreement , other than the class action waiver , is deemed or found to be unenforceable for any reason ,
the remainder is enforceable . If the class action waiver is deemed or found to be unenforceable , then this
entire Agreement will be unenforceable .

This Agreement is incorporated into and becomes a part of any retail installment contract or other credit
obligation that we enter into with you on the date you sign this Agreement .

You may opt out of this Arbitration Agreement by doing so in writing to the address shown below and
sent by registered mail , postmarked no later than 10 days from the date you sign this Agreement.

X $ 101 /2022

Buyer: KATHRYN CRYSTAL BEERS Date

Seller : FIRST STOP AUTO LLC By :

Seller's Address : 4657 US 1 UNIT A ROCKLEDGE , FL 32955 -

‫مرد‬
FZ - ARBITRATION 04/20 © 2020 Frazer Computing , LLC
 BUYERS GUIDE

IMPORTANT : Spoken promises are difficult to enforce. Ask the dealer to put all promises in writing. Keep this form .
JEEP GRAND CHEROKEE 2006 1J4HR58N06C161519
VEHICLE MAKE MODEL YEAR VEHICLE IDENTIFICATION NUMBER (VIN )

WARRANTIES FOR THIS VEHICLE :

X AS IS – NO DEALER WARRANTY

THE DEALER DOES NOT PROVIDE A WARRANTY FOR ANY REPAIRS AFTER SALE .

DEALER WARRANTY

FULL WARRANTY .

LIMITED WARRANTY. The dealer will pay % of the labor and % of the parts for the covered systems
that fail during the warranty period . Ask the dealer for a copy of the warranty , and for any documents that
explain warranty coverage , exclusions , and the dealer's repair obligations . Implied warranties under your
state's laws may give you additional rights.

SYSTEMS COVERED : DURATION :

NON - DEALER WARRANTIES FOR THIS VEHICLE :

MANUFACTURER'S WARRANTY STILL APPLIES . The manufacturer's original warranty has not expired on some
components of the vehicle .
O MANUFACTURER'S USED VEHICLE WARRANTY APPLIES .
O OTHER USED VEHICLE WARRANTY APPLIES .

Ask the dealer for a copy of the warranty document and an explanation of warranty coverage, exclusions , and repair
obligations .

SERVICE CONTRACT . A service contract on this vehicle is available for an extra charge. Ask for details about
coverage , deductible, price , and exclusions . If you buy a service contract within 90 days of your purchase of this
vehicle , implied warranties under your state's laws may give you additional rights .

ASK THE DEALER IF YOUR MECHANIC CAN INSPECT THE VEHICLE ON OR OFF THE LOT .
OBTAIN A VEHICLE HISTORY REPORT AND CHECK FOR OPEN SAFETY RECALLS . For information on
how to obtain a vehicle history report, visit ftc.gov/usedcars. To check for open safety recalls , visit safercar.gov .
You will need the vehicle identification number (VIN ) shown above to make the best use of the resources on
these sites .
SEE OTHER SIDE for important additional information , including a list of major defects that may occur in
used motor vehicles .

Si el concesionario gestiona la venta en español , pídale una copia de la Guía del comprador en español .
 Here is a list of some major defects that may occur in used vehicles .

Frame & Body Cooling System Steering System

Frame- cracks, corrective welds , or rusted Leakage including radiator Too much free play at steering wheel
through Improperly functioning water pump (DOT specs .)
Dog tracks----bent or twisted frame Electrical System Free play in linkage more than 14 inch
Engine Battery leakage Steering gear binds or jams
Oil leakage, excluding normal seepage Improperly functioning alternator, generator, Front wheels aligned improperly
Cracked block or head battery , or starter (DOT specs .)
Belts missing or inoperable Power unit belts cracked or slipping
Fuel System Power unit fluid level improper
Knocks or misses related to camshaft Visible leakage
lifters and push rods Suspension System
Abnormal exhaust discharge Inoperable Accessories Ball joint seals damaged
Gauges or warning devices Structural parts bent or damaged
Transmission & Drive Shaft Air conditioner
Improper fluid level or leakage , excluding Stabilizer bar disconnected
Heater & Defroster Spring broken
normal seepage
Cracked or damaged case which is visible Brake System Shock absorber mounting loose
Abnormal noise or vibration caused by faulty Failure warning light broken Rubber bushings damaged or missing
transmission or drive shaft Pedal not firm under pressure ( DOT spec .) Radius rod damaged or missing
Improper shifting or functioning in any gear Not enough pedal reserve ( DOT spec . ) Shock absorber leaking or functioning
Does not stop vehicle straight line improperly
Manual clutch slips or chatters ( DOT spec .)
Differential Tires
Hoses damaged Tread depth less than 2/32 inch
Improper fluid level or leakage , excluding Drum or rotor too thin (Mfgr Specs )
normal seepage Sizes mismatched
Lining or pad thickness less than 1/32 inch Visible damage
Cracked or damaged housing which is Power unit not operating or leaking
visible Structural or mechanical parts damaged Wheels
Abnormal noise or vibration caused by faulty Visible cracks, damage or repairs
differential Air Bags Mounting bolts loose or missing
Exhaust System
Leakage
Catalytic Converter

DEALER NAME
FIRST STOP AUTO LLC
ADDRESS
4657 US 1 UNIT A ; ROCKLEDGE , FL 32955
TELEPHONE EMAIL
321-351-8444
FOR COMPLAINTS AFTER SALE , CONTACT :
Add name here : M - 1-9

I hereby acknowledge receipt of the Buyers Guide at the closing of this sale .

3117
Signature Date
tough
Bery
Lathy

IMPORTANT: The information on this form is part of any contract to buy this vehicle. Removing this label before
consumer purchase ( except for purpose of test -driving ) violates federal law ( 16 C.F.R. 455 ) .
Receipt

Transaction Information

Transaction ID : c8f4n7461r8uq8c3bppo
Merchant : Reliable Auto Sales

Merchant Website :
Merchant Phone : 3214009964

Transaction Date : 03/01/2022 11:36:45 EST

Transaction Type : Sale

Subtotal : $ 4,429.00
Tax : $ 0.00

Shipping : $ 0.00
Service Fee : $ 0.00
Discount : $ 0.00

Amount Authorized : $ 4,429.00

Amount Captured : $ 4,429.00

Base Amount : $ 4,429.00
Total : $ 4,429.00
PO Number :
Order ID :

Authorization Code : 089899

Response : approved

Payment Information

Cardholder Name :

Card Type : Visa

Payment Type : card
Account # ****** ***** 8543 11/25
 A SAFER

FLORIDA TERRY L. RHODE

MAYETANO MOTOR VEHICLES EXECUTIVE DIRECTO
OFFICIAL WEBSITE SERVICE INTEGRITY COURTESY * PaOFESSIONALISM * INNOVATION X EXCELLENCE

Choose Services

Please choose one or more from the following services :

Florida Driver License : B620 -***-** -*** - O Expires : 5/31/2030
Get a Replacement License and / or change your address -- $ 25.00
( WILL NOT CHANGE YOUR EXPIRATION DATE )
Take No Action
You may make an appointment to visit a driver license office near you .
License Plate : 82KDU ( CHEVROLET ) Expires : 5/31/2022
O Renew this Registration for Vehicle for 2 years -- $ 153.05
Renew this Registration for Vehicle for 1 year -- $ 76.95
Get a Duplicate Registration -- $ 3.85 ( *** NO DECAL will be issued *** )
Take No Action

A license plate that is not currently assigned to a vehicle may be transferred to a vehicle that you buy in the future .
It may save you the $ 225 Initial Fee .

The above registration fee includes a mail fee ( $ 0.75 for registration certificate/decal or $4.70 for a license plate ) ,
which may not be reflected on your renewal notice.

Vehicle Ownerships
Below is a listing of the vehicles that you own according to department records. If your vehicle title is currently
" Electronic" and doesn't have a lien , you may request the department to print your title and mail it to you by
checking the box beside the title number. À charge of $2.50 for shipping and handling is made for each title
printed .
To remove a vehicle listed that you no longer own , please complete the Notice of Sale and/or Bill of Sale Form .
Select Title VIN Year Make Fee Title Type
82736489 4S6CK58W814408840 2001 HOND Paper
110914904 2HGEJ8647TH556528 1996 HOND Paper
144758338 1GNDT135652167218 2005 CHEV Paper

Add Selected Items to Cart

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Search > Overview > Email > Customer Address > Services > Voluntary Contribution > Item Shipping Address

MyFlorida.com Privacy Statement | Disclaimer

 AUTHORIZATION FOR CREDIT CARD USE

PRINT AND COMPLETE THIS AUTHORIZATION AND RETURN

ALL INFORMATION WILL REMAIN CONFIDENTIAL

NAME ON
CARD :

C Beers
BILLING Kathina
ADDRESS :
418 S. Brevard Ave #2
3. 2

Cocoa Beach , FL 32931

CC TYPE : VISA MASTERCARD DISCOVER AMERICAN

EXPRESS

: 8543
CARD NUMBER : 4737 0291 leolcl

EXPIRATION :
11/25

CVV : ( 3 DIGITS LOCATED ON BACK OF CARD )

lerle

AMOUNT TO
CHARGE : ( USD )
$ 4429

I AUTHORIZE EMPIRE MOTORS, LLC TO CHARGE THE AMOUNT LISTED ABOVE TO THE CREDIT CARD
PROVIDED HEREIN . I AGREE TO PAY FOR THIS PURCHASE IN ACCORDANCE WITH THE ISSUING BANK
CARDHOLDER AGREEMENT. I UNDERSTAND A 3 % CONVENIENCE FEE WILL BE APPLIED TO ALL CHARGES .

CARDHOLDER -PLEASE SIGN AND DATE

SIGNATURE : DATE :
23/122
Beed
Kathryn
PRINT NAME :
Kathna C Beers

Bathry
***ALL SALES ARE FINAL - NO REFUNDS OR EXCHANGES ***

EMPIRE MOTORS , LLC

ACCESS FINANCIAL GROUP INC

321-351-8444
 IMPORTANT INFORMATION
SECTION 316.613 , Florida Statutes, requires every operator of a motor vehicle transporting a
child in a passenger car , van, autocycle or pickup truck registered in this state and operated on the
highways of thisstate, shall , if the child is 5 years of age or younger , provide the protection of the
child by properly using a crash - tested, federally approved child restraint device . For children aged
through 3 years, such restraint device must be a separate carrier or a vehicle manufacturer's
integrated child seat . For children aged 4 through 5 years , a separate carrier, an integrated child
seat, or a child booster seat may be used .

For limited exceptions, see s . 316.613 , F.S.

S. 320.0605 , F. S. , requires the registration certificate, or true copy of a rental or lease agreement,
issued for any motor vehicle to be in the possession of the operator or carried in the vehicle while
the vehicle is being used or operated on the roads of this state .

S. 320.02 and 627.733 , F. S. , requires personal injury protection and property damage
liability to be continuously maintained throughout the registration period. Failure to maintain
the mandatory coverage may result in the suspension of your driver license and registration .

Mail To : Importan note : If you cancel the insurance for this vehicle,
KATHRYN CRYSTAL BEERS immediately return the license plate from this registration to a Florida
418 S BREVARD AVE APT 2 driver license or tax collector office or by mail to : DHSMV , Return Tags ,
COCOA BEACH , FL 32931 2900 Apalachee Parkway, Tallahassee, FL 32399. Surrendering the plate
will prevent your driving privilege from being suspended.

CO/AGY 69/06 T# 1611419943

B#
FLORIDA VEHICLE REGISTRATION
PLATE DDA3643 DECAL Expires Midnight Wed 03/30/2022
YR/MK 2006 / JEEP BODY 4D COLOR AME Reg. Tax 2.00 Class Code 13
VIN 1J4HR58N06C161519 TITLE Init Reg . Tax Months
Plate Type TDL NET WT 3496 County Fee Back Tax Mos
Mail Fee Credit Class
DL/FEID B620503806910 Sales Tax Credit Months
Date Issued 03/01/2022 Plate Issued 03/01/2022 Voluntary Fees
Grand Total 2.00
IMPORTANT INFORMATION
1. The Florida license plate must remain with the registrant upon sale of vehicle.
KATHRYN CRYSTAL BEERS
418 S BREVARD AVE APT 2 2. The registration must be delivered to a Tax Collector or Tag Agent for transfer to
a replacement vehicle .
COCOA BEACH , FL 32931 3. Your registration must be updated to your new address within 30 days of moving .
4. Registration renewals are the responsibility of the registrant and shall occur during
the 30 - day period prior to the expiration date shown on this registration. Renewal
notices are provided as a courtesy and are not required for renewal purposes .
5. I understand that my driver license and registrations will be suspended
immediately if the insurer denies the insurance information submitted for this
registration .

TDL - PRINT ON DEMAND TEMP PLATE

 USA

Florida
DRIVER LICENSE
CLASS E

43 OLB620-503-80-691-0
BEERS
2KATHRYN CRYSTAL
3418 S BREVARD AVE APT 2
COCOA BEACH , FL 32931

3008 05/31/1980 155TX F

46 EXP 05/31/2030 16HGT 6 ' 04"
12 REST NONE 98 END NONE

POOHOR
SAFE DRIVER

4x SS 11/19/2021

5DD H712111190088

Operation of a motor vehicle constitutes

Kathryn Bus consent to any sobriety test required by law .
Invoice No. AutoNation
TOWING POLICY STRICTLY ENFORCED
TITLE NUMBER ISTATE SALE DATE RUN NO .
AUTO AUCTION
ITIME SOLDI 12/30/2021 AA - 0233
AutoNation Auto Auction Orlando
16:44 650 N. US Highway 17-92
TITLE RECEIBT STOCK NO
BID NOA Longwood, FL 32750
407-961-4300 HAND DELIVERED MAIL
135909
0132 INITIALS
DATE INITIALS DATE
YEAR MAKE MODELISUB SERIES BODY COLOR OPTIONS SERIAL NUMBER
DT : 4X4 FUEL : G
2006 JEEP GRAND CHEROKEE LIM 4DR | BLACK 1J4HR58N06C161519
ENGINE : 4.7L 08 CY
YELLOW IGREEN RED BLUE

XX * UA
N N U T
TITLE
LISTEN TORME LAS IS ATTACHED
MILEAGE
SELLER (TRANSFEROR ) AN2159
183123 EXEMPT DIGITAL
MERCEDES BENZ OF WESLEY CHAPEL
2383 WILLOW OAK DR SELLERS CHECK HAND DELIVERY
WESLEY CHAPEL , FL 33544 DATE CLERK MAILED
License # : VF10887161
ODOMETER DISCLOSURE STATEMENT Section 580.5 Disclosure form .
Federal law (and State law , if applicable) requires that you state the mileage upon transfer
of ownership. Failure to complete or providing a false statement may result in fines and/or
imprisonment.
( 1 ) I hereby certify that to the best of my knowledge the odometer reading
reflects the amount of mileage in excess of its mechanical limits.

(2) I hereby certify that the odometer reading is NOT the actual mileage -
WARNING ODOMETER DISCREPANCY .
I agree to sell and am authorized to sell above vehicle to Buyer for the
below Purchase Price. Further, I agree to abide by Auction Policies,
which I am familiar with and have in my possession . I, MERCEDES BENZ OF WESLEY CHAPEL
Printed : 12/30/2021; 17:18:35 Print Transferor's Name (seller)
state that the odometer now reads 183123 EXEMPT
1. OR WE BY USE OF OUR PLATE OR AUTHORIZED SIGNATURE , HEREBY
AGREE TO PAY THE INDICATED SALE PRICE FOR THE VEHICLE DESCRIBED IN miles (no tenths) and to the best of my knowledge that it reflects the actual mileage of the
THE ATTACHED VOUCHER UNDER THE TERMS AND RULES OF AMERICA'S AUTO vehicle described above, unless one of the above statements is checked .
AUCTION

R00156 Bid # 0132 х х

PURCHASER /BUYER ( TRANSFEREE )
TRANSFEROR'S SIGNATURE (SELLER ) PRINTED NAME OF SIGNOR
RELIABLE AUTO SALES
850 N COURTENAY PKWY
* NO RETAIL SALES
MERRITT ISLAND , FL 32953 * ALL VEHICLES SOLD TO DEALERS FOR RESALE ONLY WITHOUT WARRANTY
License : VI11342482 * AUCTION ASSUMES NO RESPONSIBILITY NOR GUARANTEES THE ACCURACY OF THE ODOMETER READING
* AUCTION ACCEPTS NO RESPONSIBILITY FOR THEFT , LIABILITY OR PROPERTY DAMAGE
321-604-6716 • 72 HOURS APTER PURCHASED DATE BUYER WILL BE ASSESSED STORAGE AND LATE FEES
CHECK NO. DATE RAID CASH NO DEPOSIT DATE
BUYER
I am authorized to act on behalf of the below dealership ( if listed ) and INFORMATION
agree to purchase the above vehicle . I agree that I have examined the
vehicles and accept vehicle and title in its present condition . I agree to
and am familiar with the terms and conditions of Auction's Standard Sale TOTAL $
Contract and agree to allow Auction to complete a sale contract for this OFFER $
SELLING
vehicle on my behalf. Further, I am familiar with , have in my BUYER'S PRICE S
possession and agree to abide by the Policies and Procedures of Auction . FEE $ 2,600.00

SELLER
321-604-1976 DACCEPTED BUYERS
R COUNTERS FEE $ 295.00
X JUSTIN ASHNESS
REPRESENTATIVE 1
PRINTED TRANSFEREE'S NAME ( BUYER )
BUYER
D ACCEPTED DEAL SHIELD
Х DECLINED
产 FEE $
TRANSFEREE'S SIGNATURE ( BUYER) D COUNTER $
REPRESENTATIVE
OFFICE AMOUNT
AUCTIONEER CLERK
CLERK DOE 2,895.00
SR GOODWINT TIME COMPLETE

TIJIS SALE IS SOLELY A TRANSACTION BETWEEN BUYING AND SELLING DEALERS NO REPRESENTATION OF TITLE TO THIRD PARTIES IS MADE OR INTENDED SUBJECT TO TERMS AND CONDITIONS ON REVERSE SIDE OF THIS PAGE