STATE CALIFORNIA

TEXAS DEPERTAMENT OF MOTOR VEHICLES

VEHICLE IDENTIFICATION NUMBER YEAR MODEL MAKE OF VEHICLE BODY STYLE

MH3RH20Y8MK004097 YAMA DC
DOCUMENT NUMBER DATE TITLE ISSUED

29700039949110430 05/18/2021
MODEL MFG. CAPACITY WEIGHT LICENSE NUMBER
IN TONS
MOTO Mt03 321 CC 2 **** 3450
EDICION ESPECUAL 50 ANIV.
PREVIOUS OWNER
BENJAMIN JOHNSON
KILLEEN, TX
REMARK(S)

OWNER
NOT ACTUAL MILEAGE
FOREMOST COUNTY MUTUAL
4510 S MADISON
WICHITA, KS 67216

X
SIGNATURE OF OWNER OR AGENT MUST BE IN INK

UNLESS OTHERWISE AUTHORIZED BY LAW, IT IS A VIOLATION OF STATE LAW TO SGN THE

NAME OF ANOTHER PERSON ON A CERTIFICATE OF TITLE OR OTHERWISE GIVE FALSE
INFORMATION ON A CERTIFICATE OF TITLE.

DATE OF LIEN 1ST LIENHOLDER

1ST LIEN RELEASED

DATE

BY
AUTHORIZED AGENT
DATE OF LIEN 2ND LIENHOLDER

2ND LIEN RELEASED

DATE

BY
AUTHORIZED AGENT
DATE OF LIEN 3RD LIENHOLDER

3RD LIEN RELEASED

DATE

BY
IT IS HEREBY CERTIFIED THAT THE PERSON HEREIN NAMED IS THE OWNER
OF THE VEHICLE DESCRIBED ABOVE WHICH IS SUBJECT RO THE ABOVE LIENS. AUTHORIZED AGENT

R I G H T S O F S U R V I V O R S H I P A G R E E M E N T
WE, THE MARRIED PERSONS WHOSE SIGNATURES APPEAR HEREIN, HEBERY SIGNATURE DATE
AGREE THAT THE OWNERSHIP OF THE VEHICLE DESCRIBED ON THIS
CERTIFICATE OF TITLE SHALL, FROM THIS DAY FORWARD BE HELD JOINTLY, AND
IN THE EVENT OF DEATH OF ANY OF THE PERSONS NAMED IN THE AGREEMENT,
THE OWNERSHIP OF THE VEHICLE SHALL VESTIN THE SURVIVOR(S) SIGNATURE DATE

SIGNATURE DATE
FORM 30-C REV. 8-94
DO NOT ACCEPT TITLE SHOWING ERASURE, ALTERATION, OR MUTILATION.
 WHEN VEHICLE IS SOLD , TITLE HOLDER MUST AS SIGN AND FURNISH THIS TITLE, CORRENT LICENSE RECEIPT , AND
SALES TAX AFFIDAVIT TO THE PURCHASER WHO MUST FILE APPLICA TION WITH COUNTY T AX ASSESSOR-COLLECTOR
WITHIN 20 WORKING D AYS TO AVOID $10 PENAL TY.
FEDERAL AND ST ATE LAW REQUIRES THA T YOU STATE THE MILEAGE IN CONNECTON WITH THE TRANSFER OF
OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A F ALSE STATEMENT MA Y RESULT IN FINES AND/OR IMPRESONMENT .
The undersigned hereby certies that the vehicle described in this title is free and clear of all liens, except as noted herein, and has been transferred to the following printed name and address:

Name of Purchaser Street City State Zip

ASSIGNMENT

I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked:
OF TITLE

1. The mileage stated is in excces of its mechanical limits.

2. The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
ODOMETER READING (No Tenths)
Date of
Sale
Signature of Seller/Agent Printed Name (same as signature)
I am aware of the above odometer certication made by the seller/agent.

Signature of Buyer/Agent Printed Name (same as signature)

The undersigned hereby certies that the vehicle described in this title is free and clear of all liens, except as noted herein, and has been transferred to the following printed name and address:
FIRST REASSIGNMENT

Name of Purchaser Street City State Zip

I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked:
DEALER ONLY

1. The mileage stated is in excces of its mechanical limits.

ODOMETER READING (No Tenths)
2. The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
Date of Date of
Sale Sale
Dealer´s Name

Agent´s Signature Printed Name (same as signature)

I am aware of the above odometer certication made by the seller/agent.

Signature of Buyer/Agent Printed Name (same as signature)

The undersigned hereby certies that the vehicle described in this title is free and clear of all liens, except as noted herein, and has been transferred to the following printed name and address:
SECOND REASSIGNMENT

Name of Purchaser Street City State Zip

I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked:
DEALER ONLY

1. The mileage stated is in excces of its mechanical limits.

ODOMETER READING (No Tenths)
2. The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
Date of Date of
Sale Sale
Dealer´s Name

Agent´s Signature Printed Name (same as signature)

I am aware of the above odometer certication made by the seller/agent.

Signature of Buyer/Agent Printed Name (same as signature)

The undersigned hereby certies that the vehicle described in this title is free and clear of all liens, except as noted herein, and has been transferred to the following printed name and address:
THIRD REASSIGNMENT

Name of Purchaser Street City State Zip

I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked:
DEALER ONLY

1. The mileage stated is in excces of its mechanical limits.

ODOMETER READING (No Tenths)
2. The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
Date of Date of
Sale Sale
Dealer´s Name

Agent´s Signature Printed Name (same as signature)

I am aware of the above odometer certication made by the seller/agent.

Signature of Buyer/Agent Printed Name (same as signature)

LIEN

LIENHOLDER TO BE RECORDED AND SHOWN ON NEW TITLE:

1ST LIEN IN FAVOR OF (NAME & ADDRESS)