Parts Vehicle Bill Of Sale
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1Nebraska Department of Motor Vehicles
PARTS VEHICLE
BILL OF SALE
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This form is used for the transfer of a vehicle:
−
when the title has been surrendered to the Nebraska Department of Motor Vehicles as evidenced by
a junked status entry on the vehicle record; or
−
when the title has been surrendered to any other state’s Department of Motor Vehicles to render the
vehicle fit for sale for scrap and parts only.
DATE OF SALE
(MO/DAY/YEAR)
I,
in consideration of the payment of the sum of $
Seller PLEASE PRINT
acknowledge receipt of payment from
and do hereby sell and
Purchaser PLEASE PRINT
transfer ownership of the parts vehicle described below:
Year
Make
Model
VIN
Owner (Seller) Information
Purchaser Information
Full Name
Full Name
Residential Address
Residential Address
Mailing Address
Mailing Address
City State Zip
City State Zip
Phone Number
Phone Number
I,
certify to the best of my knowledge that the odometer
Seller PLEASE PRINT
reading is the actual mileage of the vehicle unless one of the statements below is checked:
Odometer Reading:
The mileage stated is in excess of mechanical limits.
Reading is NOT actual mileage –
WARNING ODOMETER DISCREPANCY
Seller’s Signature
Purchaser’s Signature
Any person, firm, association, partnership, Limited Liability Company or corporation that uses this Parts
Vehicle Bill of Sale to transfer ownership of a vehicle that does not meet the criteria described above and/or
provides false information may be subject to a fine or imprisonment or both.
01/2014
301 Centennial Mall South ● PO Box 94789 ● Lincoln, NE 68509-4789 ● (402) 471-3918
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