NOTE: Load and read the SAMPLE2A.txt copy before attempting to fill out this Automobile Bill of Sale form. The numbers in parentheses refer to sections in the SAMPLE2A.txt that explain how to fill in the "blanks" below. Notes on how to properly use this form are also provided. BILL OF SALE--AUTOMOBILE KNOW ALL MEN by these presents, that on this ____________ (1) day of ________________________ (2), 199__ for the consideration of _____________ (3) dollars ($_________) paid by _____________________ (4) of sufficiency of which is hereby acknowledged, __________________________ (6) does hereby grant, bargain, sell, convey and deliver to __________________________ (7) the following described motor vehicle: Make: ___________________________ (8) Model: __________________________ (9) Body type: ______________________ (10) Year: ___________________________ (11) Color: __________________________ (12) VIN: ____________________________ (13) Other: __________________________ (14) TO HAVE AND TO HOLD the same unto ______________________ (7) and his/her executors, administrators and assigns, forever. AND ___________________ (6) hereby covenants to and with _____________ (7) that __________________ (6) is the lawful owner of the above described motor vehicle, that the same is free from all encumbrances whatsoever except ____________________ (15), that ___________________ (6) has good title and the right to sell the same as aforesaid, and that _____________________ (6) will warrant and defend the same against all lawful claims and demands whatsoever except ___________________ (16). WITNESSES: _______________________________ (17) (4) _______________________________ Witness #1 Buyer _______________________________ (17) (6) _______________________________ Witness #2 Seller ____________________________ NOTARY PUBLIC In and For _________________ (18) of _________________________ (19) My Commission Expires: __________ (Seal) Whenever an automobile is sold, the following Odometer Disclosure Statement must also be completed by the seller and signed by both the seller and buyer. In the first paragraph, the seller should fill in his name and the exact odometer reading. He/she should also check one of the two statements that follow (only if they apply) and fill in the vehicle information. Both parties must sign the statement. ODOMETER DISCLOSURE STATEMENT Federal law (and State law, if applicable) requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment. I, _________________________, state that the odometer now reads _________________ (no tenths) miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described below, unless one of the following statements is checked. _____ I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. _____ I hereby certify that the odometer reading is NOT the actual mileage. WARNING--ODMOTER DISCREPANCY. Make: ______________________________________ Model: ________________________ Body Type: _________________________________ Year: _________________________ Vehicle Identification Number (VID): __________________________________________ __________________________________ ___________________________________ (Seller's Signature) (Buyer's Signature) __________________________________ ___________________________________ (Seller's Printed Name) (Buyer's Printed Name) __________________________________ ___________________________________ (Seller's Address) (Buyer's Address) __________________________________ ___________________________________ (City) (State/Zip) (City) (State/Zip) Date of Statement: ___________________________