Form Rv-1 - Boat Dealer Registration Instructions Page 47
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69New York State Department of Motor Vehicles
MV-901B (9/10)
GARAGEMAN’S AFFIRMATION AND BILL OF SALE
This form is also available to download from the DMV website:
GARAGEMAN (Business Name and Address)
PRIOR OWNER
Name
Facility No.
Last Name,
First, M.I.
Number and
Number and
Apt. No.
Street Address
Street Address
City
State
Zip Code
City
State
Zip Code
DESCRIPTION OF VEHICLE OR BOAT
Make
Model
Plate Number
State
Vehicle or Hull Identification Number (attach photo or tracing)
Year
LIENHOLDERS (attach additional sheet, if necessary)
1. Name
2. Name
Number and
Apt. No. Number and
Apt. No.
Street Address
Street Address
City
State
Zip Code
City
State
Zip Code
I (We) waited 10 days from the date of service of the Notice of Lien to publish the notice of impending sale, and waited 15 days from the date of the first publication
of the notice to conduct the sale. No action was brought under Section 201-a of the Lien Law, or an action was brought and the determination was in my (our) favor.
Notice of Lien was sent to owner(s) and lienholder(s). Proof of mailing is attached. The sale was published in accordance with Section 202 of the Lien Law.
PUBLICATION AND SERVICE OF NOTICE INFORMATION
Date of service of notice to owner:
/
/
Date of service of notice to lienholder(s):
/
/
1st Publication Date:
/
/
2nd Publication Date:
/
/
Sale Date:
/
/
Name and address of newspaper:
BUYER
Print Last Name,
Address Where Auction Was Held
First, M.I.
Number and
Apt. No.
Street Address
PRICE PAID:
($0 [zero dollars]
City
State
Zip Code
is not acceptable)
ODOMETER DISCLOSURE STATEMENT (does not apply to boats)
Federal and state laws require that you state the mileage and condition of the vehicle described above when transferring ownership of it to
someone else. If you do not give the mileage and condition information to the new owner(s), or if you give false mileage information, you may
be subject to fines and/or imprisonment.
I, _____________________________________________________________ state that the odometer now reads ___________________miles
Garageman, Print Name in Full
(no tenths)
The odometer on the vehicle described above has (check the appropriate box):
5 digits
6 digits
7 digits, not including tenths.
1.
I certify that, to the best of my knowledge, this odometer reading reflects the ACTUAL MILEAGE as seen on the odometer of the
vehicle described above.
2.
I certify that, to the best of my knowledge, this odometer reading “EXCEEDS MECHANICAL LIMITS”. (Odometer started over at zero).
3.
I certify that, to the best of my knowledge, this odometer reading is
“NOT THE ACTUAL MILEAGE WARNING: ODOMETER DISCREPANCY”.
DAMAGE DISCLOSURE STATEMENT – CHECK ONE BOX
I certify that, to the best of my knowledge, this vehicle
has been or
has not been wrecked, destroyed or damaged to such an extent that the
total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and for legal
operation on the road or highways, is more than 75% of the retail value of the vehicle at the time of loss. (Checking the “has” box means the
vehicle must have an anti-theft examination before being registered and that the title issued will have the statement “Rebuilt Salvage: NY” on it.)
The information in these statements is true to the best of my knowledge.
_________________________________________________
_____________________________________________
(BUYER’S SIGNATURE)
(GARAGEMAN’S SIGNATURE)
IMPORTANT: False statements are punishable under Section 392 of the Vehicle and Traffic Law and Section 210.45 of the Penal Law.
CERTIFICATE OF TITLE REQUIRED FOR REGISTRATION
The vehicle described above cannot be registered until Title Services has reviewed the buyer’s application for title and supporting
documentation, and issued a Certificate of Title for the vehicle.
-F32-
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