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2. Seller / Donor:
4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Buyer / Donated To:
17. First Name
18. Last Name
20. Address1
22. Address2
24. City
25. State
26. Zip
28. Date Sold / Donated
    Date Sold / Donated
30. Description of Vehicle or Boat
    (Year, model, etc.)
32. Subscribed to Under Penalties of Perjury
34. Date
    Date
36. Signature
38. Address1
40. Address2
42. City
43. State
44. Zip
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field