Form Mv-905 - Self-Storage Owner/operator Affirmation And Bill Of Sale printable pdf download

SELF-STORAGE OWNER/OPERATOR AFFIRMATION AND BILL OF SALE

This form is also available to download from the DMV web site dmv.ny.gov

SELF-STORAGE COMPANY (Business Name and Address)

PRIOR OWNER

Name

Last Name, First, M.I.

Number and Street Address

Number and Street Address (including Apt. No.)

State

Zip Code

City

State

Zip Code

DESCRIPTION OF VEHICLE OR BOAT

Vehicle or Hull Identification Number (attach photo or tracing)

Make

Model

Plate Number

State

Year

LIENHOLDERS (attach additional page, if necessary)

1. Name

2. Name

Number and Street Address (including Apt. No.)

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 182 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.

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, First, M.I.

Address Where Auction Was Held

Number and Street Address (including Apt. No.)

City

State

Zip Code

Price

Paid

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. Failure to

provide mileage and condition information, or providing false information, may result in fines and/or imprisonment.

I, ___________________________________________________________ state that the odometer now reads ___________________miles.

Self-Storage Owner/Operator (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.

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.

I certify that, to the best of my knowledge, this odometer reading “EXCEEDS MECHANICAL LIMITS”. (Odometer started over at zero.)

“NOT THE ACTUAL MILEAGE. WARNING: ODOMETER DISCREPANCY”.

I certify that, to the best of my knowledge, this odometer reading is

Making a false statement, or failure to accurately disclose the salvage status of a vehicle, may subject you to substantial civil

IMPORTANT:

fines, in addition to any penalties authorized by the Penal Law.

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 the “Statements” above is true to the best of my knowledge.

_________________________________________________

_____________________________________________

(BUYER’S SIGNATURE)

(SELF-STORAGE OWNER/OPERATOR’S SIGNATURE)

CERTIFICATE OF TITLE REQUIRED FOR REGISTRATION

The vehicle described above cannot be registered until Title Services Bureau staff have reviewed the buyer’s application for title and

supporting documentation, and have issued a Certificate of Title for the vehicle.

MV-905 (11/15)

Form Mv-905 - Self-Storage Owner/operator Affirmation And Bill Of Sale

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