Metric Diagnostic Testing Inc Plaintiff vs. Geico General Insurance Company Defendant, COWE17008358, 06-10-2020_Notice of Filing Affidavit (Fla. Broward Cty. Ct. Jun. 10, 2020) (2024)

`

`Mar 11 2516 15:1?l56
`
`13666563266
`
`—>
`
`3495435165717334435 Geicn
`
`Page 332
`
`SN THE COUNTY CUURT 1N AND
`FQR BRQWARD CQ-UNTM F‘LMCDRIDA
`
`Cam N0“: CGNO “2&0’13236 (7’0)
`
`LAKES TOWN REHAB CENTER,
`iNIC.(a/alo Beehemmee Kefiely).
`
`V.
`
`Piaintiff,
`
`GEHCO GENERAL INSURANCE?
`COMPANY ,
`
`Defendant.
`WMWm—WWWMMNM—um...............
`
`/
`
`AFFICJAVIT OW TANYA VIE-RA
`
`SS.
`
`))
`
`)
`
`STATE OF FLORIDA
`
`QQUNTY OF: POLK
`
`the undersigned authority, pereonauy appeared
`BEFORE ME,
`adjueter Tanya View, who, after being duly eworn states are fellows:
`
`1. My name is "Tanya Viera and i am of Rage! age and campe‘tem to testify
`to the following based on my persona! knowledge.
`
`22.
`
`3”
`
`am ampmyed by (SEED GENERAL INSURANCE?) COMPANY
`I
`(hereinafter “Defendant") a5 a P1P {mitigation Adjuster.
`
`I have reviewed this me in its; entirety and thie affidevit i3 imam cm my
`persona? knowredge of this file and my experience adjusting ciaims.
`
`requested and received the attached certified official
`4. Defendant
`lemma cf the State 01’ Florida—3’5 Department Qf Highway Safety and
`Motor Vehiciee' Dévieton of Motoriet Services pursuant to a certified
`remrd requeet an December 22, 20M. A com Off/m Cem'fied Regards
`of the Morfda papa/“invent of Highway Safety and Mentor Vania/95’
`Division of Material Services‘ 113 attached hetero as: Exhibit A
`
`5‘ The attached eertified records; confirm that Kettely {Deehommem
`Julian wee {he regziatered ewner 0f «31 2906 Niesen motor vehime from
`
`

`

`Mar 11 2516 15:13:17
`
`13666563266
`
`—>
`
`3495435165717334435 Geicn
`
`Page BBB
`
`March 231» 2011 mm! Augum $3, 2014‘ or at least unfit the mgémm’tim
`was renewed or) Augugt 29, 2012. 5629 Exhibit "A" attached.
`
`6. The above—rafarenmed Nissan motor vehicie was not
`any palmy 0f insurance with Defmwdant.
`
`imaured under
`
`K 3 have. raviaweci the exhibi‘rs mttaohad harem and d0 immby attaat that
`all area true and correct copies of the Originals:- which are kept in the
`orciimary comm of Dafmdant’g bqu‘uem.
`
`FURTHER AFFI’ANT SAYFE?H NAUGHTV
`
`
`
`ESTATE {SF FLORWJA
`
`GQUNW 05—" POLK
`
`)
`
`)
`
`, ”ff 5} {5; before me:
`1
`On “143
`to me known to be the person
`"
`‘
`persanailty appeare
`name-2d Wrcin and who executed the: fOreQQing and ackmwlaadgad to me that am:
`voluntariiy executad the same.
`I”
`
`
`'
`'
`‘
`W m
`
`“f
`
`‘
`
`{
`
`]
`
`Personality known to me,
`an Wm,
`
`Dirj exhibit t0 ma F‘iorida
`
`Dfiver License No.
`My Commswiwn Mamba“;
`
`My Commiasian Expirea;1;
`
`

`

`02 O4 15
`
`ASAFER
`
`LL9_fiIna
`
`711m
`
`DEPARTMENTOFHIGHWAYSAFETYANDMOTORVEHICLES WE
`
`DIVISION OF MOTORIST SERVICES
`2900 Apalachee Parkway. Room 3231. Mail Stop 91
`Neil lGIkman BuildIng Tallahassee FL 32399
`
`MOTOR VEHICLE, VESSEL AND MOBILE HOME RECORDS REQUEST
`FEES ARE REQUIRED AT TIME OF REQUEST AND ARE PAYABLE TO DIVISION OF MOTORIST SERVICES.
`PLEASE ALLOW A 2- WEEK PROCESSING TIME FROM THE DATE WE RECEIVE THIS REQUEST
`
`
`
` 56'Isoeeeaaee1‘389—5140
`
`,equester's nformation.
`
`
`Name of Requester
`
`174(2le
`- anDVQQboO/o/ob
`Date
`Reference # (Case/File Name)
`’55 w . Panto _5/'_’7____ QCIOHQIGJQgQILOLDM.
`
`
`You ma attach a se - arate sheet for additional re - uests. ' Current Re ‘
`
`Street Address
`
`EmaIl Ad
`
`55
`
`'_
`
`To recere personal Information. indIcate the
`‘
`‘
`exemption number(s) from list. ' If you request your
`own personal information, see note below.
`r4.
`538M
`Ql/hfao/OECL/
`'
`State
`Zip
`‘
`Fax Number
`Under penalty of perjury, ! affirm that I am entitled to receive this information and understand that
`i may not redisclose this information according to the Driver Privacy Protection Act except as
`provided'In section 1190712(2), Florida Statutes.
`Regulate/£132!
`,
`fig; 00)
`.
`
`
`ontact PersonSi nature of Re uester o Tele hone Number
`‘NOTE: ifre . uestin - our own . ersonal information ou must include-' our DL/Ib or social securl number and si- n this re- uest.
`
`I
`
`II.
`
`,
`
`City
`
`I:I Mobile Home (Records are available up to 10 years) -
`Type of Record Request: w Motor Vehicle E] Vessel
`@ Certified Record Request (An additional $3.00 is required per record)
`
`ingfluiboenfluéb“ III—Lem 23w
`.
`PmRHW
`VlN/HIN Number
`Make
`Year
`‘
`TItle Number
`License Plate or FL#
`El Current RegIstered Owner
`OR
`\fiwnemas of): Month 0“, Day OI Year 'Z’DIZ
`Title Record Re - uest B - Vehicle/Vessel ldentification Number or Title Number Onl
`
`‘
`
`[iii/i 2-1.“ liggggoiogsci
`VlNlHlN Number
`‘
`V
`
`TItle Number
`
`[34itle History Printout (lists owner(s) of vehicle) - $1.00
`8 ecific Title Transaction - 1.00
`r Pa
`I]
`p
`5
`Fe _
`9e
`(Month. Day and Year)
`
`EComplete Title History (scanned lmages)- $15.00
`We request $15.00 as initial payment for each record. The fee is $1
`per page. If addltlonal fees are required. we will contact you.
`
`MOTOR VEHICLE RECORD REQUEST BY NAME AND PERSONAL INFORMATION - $ .50 Each.
`
`.
`Request for Letter(s) of Verification:
`Examples “this reqUest are forgpecmc inbmamdsuch as
`make. model or body type of motor vehicle, or address on record
`for a certain date, etc.
`
`Identify what information needs to be stated in the letter of
`.
`,
`.
`.
`.
`. .
`venfication or what specIfically you are requesting. (If addItIonal
`space IS needed you may attach a separate sheet.)
`
`Date of Birth
`
`‘ Driver LicensellD number
`
`Social Security#
`
`[I Letter of Verification - $1.00 each
`El Certified Letter ofVeritication - $4.00 each
`HSMVSDS10-Revised09l13
`'
`6D I
`
`'
`
`'
`
`-
`
`37'
`
`‘\
`
`-
`
`‘
`
`.
`
`I "Q
`
`at??? Vi": termV79
`
`.
`
`'
`
`'
`
`a:
`g
`
`
`
`

`

`
`02 O4 15
`
`PAGE:
`1
`~ FLORIDA DEPARTMENT OF HIGHWAY'SAFETY
`mucosa,
`RUN DATE: 01/02/2015
`68/31
`MOTOR VEHICLE INQUIRY REPORT
`COUNTY]1}?ch :\f
`RUN TIMER110359
`VEHICLE INFO
`1N4AL11D06N3 9 0 859
`AU
`NET WEIGHT:
`3072
`13333
`GVW:
`A
`VEHICLE USE:P
`M
`FUEL TYPE:
`03/21/2011
`MAJOR COLOR:GRN
`TITLE INFO
`PENDING:NO
`
`VEHIanf’ID mm:
`VEHICLE TYPE:
`ODOMETER MILES:
`ODOMETER STATUS:
`encore-r53 TYPE:
`ODOMETER DATE:
`
`TITLE NUMBER:
`ISSUE DATE:
`SALVAGE TYPE:
`TITLE STATUS:
`
`95747729
`03/21/2011
`TRANSFER
`
`YEAR MAKE:
`VEHICLE MAKE:
`BODY:
`.
`IN'HOUSE MAKE:
`. MINOR COLOR:
`«
`CANCEL DATE:
`CANCEL STATE:
`EFS STATUS:
`ELT STATUS :
`
`JUR:
`
`BRAND DATE:
`
`BRAND INFO
`N0 BRANDS ON FILE
`OWNER INFO
`
`5450500717890
`00/09/1971
`/
`JULIEN, KETTELY
`7023 NW 38TH ST
`CORAL SPRINGS, FL
`
`F
`
`CUSTOMER STOP ON FILE
`
`33065
`
`OWNER NUMBER:
`RES COUNTY:
`'
`
`ANRH84
`RGS
`03/21/2011
`11.20
`PR
`001
`
`REGISTRATION INFO v
`
`'
`‘
`. DECAL NUMBER:
`DECAL YEAR:
`ISSUE DATE:
`_
`EXPIRE DATE:
`UNIT MIN/FLEET:
`LOCATION CODE:
`
`00782438
`2014
`08/29/2012
`08/09/2014
`
`REGISTRANT INFO‘
`
`V
`
`'
`
`'
`.
`REGISTRANT NUM:
`,
`5450500717890
`F CUSTOMER STOP. ON FILE RES COUNTY:
`03/09/1971
`/
`JULIEN, KETTEL'!’
`7023 NW 38TH ST
`CORAL SPRINGS, FL
`
`33065
`
`BRAND CODE :
`
`FEID/DL NUMBER:
`1313-1-11 DATE/SEX:
`OWNER NAME:
`OWNER rum:
`
`LEGAL OWNERSHIP:
`
`LICENSE PLATE:
`PLATE CODE:
`ISSUE DATE:
`ARF CREDIT:
`REG USE:
`CLASS CODE:
`COMMENTS:
`
`FEID/DL N'U'DEER:
`REGIS. DOB/SEX:
`REGISTRANT NAME:
`REGISTRANT ADDR:
`
`FEID/DL NUMBER:
`LIEN DOB/SEX:
`LIEN DATE:
`
`’
`
`
`
`
`LIEN HLDR NAME:
`LIEN HLDR ADDR:
`
`‘
`
`BRUTUS, RONALD
`NOT AVAILABLE
`
`13632720744171
`11/17/1974
`/
`03/21/2011
`
`LIEN HOLDER INFO
`
`M
`
`LIEN
`RECEIVED:
`
`LIEN NUMBER:
`RES COUNTY:
`03/21/2011 ELT FLAG:
`v
`
`I. Maureen Johnson. Chief, Bureau ofRecords, Division.
`of Motorist Services, Department of nghway Safety arm
`Motor Vehicles at the State of Florida. do hereby comfy
`that this Is a true and correct copy of the motor vehlole or
`driver license record from the official records on file In this
`department.
`
`

`

`02 O4 15
`
`
`SCAN TRANSACTION NUMBER
`16 82 6 7 5 1 6
`
`
`
`
`IIIIIRIIIIPIIIEIIIIIIIIIHHII
`"““W
`w 1726504
`I
`1449765
`W 657782247
`STA'IEdFFLORJDA
`3“
`APPLICATIONFOR VBI-IICLBNBSSEL
`
`CERTIFICATE OF TITLE
`
`
`.va
`'
`MAKEor
`BODY
`Tn'LE NUMBER
`VEHICLE/VESSEL IDENTIFICATION I:
`YR. MAKE Mmflmfim
`VEHICLECOLOR WT/LENG'I'H
`ILoc
`_5747729 _N4AL11D06N390859 2006-‘E:l -:-m-3012-u|m:
`
`
`
`DATEOFISSUE TRANS_HULL
`VESSEL
`M0.DAY YEAR 00-05 VEHICLEUSE
`MATERIAL
`PROPULSION
`WATER
`III-NUMBER
`-
`DESTRUCTION
` BIRTHDATE
`ApplicanI/Ownm’s Name Ii Address
`
`
`KET’I‘ELYDESHOI‘VIMES
`M”71
`7023 NW33TH ST
`owmsa mm on
`CORAL SPRINGS. FL 33065
`‘5" mm:
`
`
`
`
`
` Actiox} Requested: TRANSFER'I‘IILE
`
`VOLUNTARY CONTRIBUTIONS
`
`
` AGENCY TnLE FE SALESTAX GRAND TOTAL
`
`
`
`-
`
`-
`
`SEX MO. DAY YEAR
`
`RESIDENT
`N
`ALIEN RESII
`
`2mowwsa 1-1an on
`mm H
`
`
`
`
`DATEAGOUIRED
`0DONETEFIIVESSELMANUfa*gTUHER
`ODDMEI'ER
`
`
`
`03/21/2011
`
`
`
`13.333 MILES 03/21/2011 ACTUAL
`[J ‘ ggmgxggu
`
`DATEOF LIEN
`0312112011
`
` LIEN INFORMATION
`DMV account»
`_
`FEIDIIOH FLIDL AND SEXAND DATE OF BIRTH
`RECEIVED DATE
`31721498
`03/2112011 _ MALE 11/17/1974
`NAME OF FIHSI'IJENHOLDEH.
`
`
`
`RONALD BRUTUS
`
`ADDRESS
`SALVAGETYPE
`
`
`754 NW 117TH ST
`
`
`MIAMI, FL 33168-2323
`
`SELLER INFORMATION .
`
`NAME OFSELLER‘ FLORIDA DEALER. OF! OTHER PREVIOUS OWNER
`
`ADDRESS ~
`
`
`
`DEALER LICENSENO.
`
`
`
` SALES TAX AND USE REPORT
`INDICATETOTAL PURCHASE PRICE. INCLUDING ANY
`S
`21500 00
`UNPAID BALANCE DUESELLER. BANK OR OTHERS
`
`TRANSFER OF TITLE U PURCHASER HOLDS VALID
`I
`
`
`IS EXEMPT FROM
`EXEMPTION CERT:FICATE
`INDICATE SALES DH USEIT'AX DUE AS PROVIDED BY CHAPTER 5
`150’00
`
`
`
`
`
`momma. sums on El «mamas I vasssn mm. 32
`212. neanmmm :‘i '
`“53 Tex FOR ms:
`uszn Excmsmmmoamsmmf:923153 "cs-0.10"?"41..-?" ,.
`
`
` El SELLING PRICE VERIFIED
`msm‘s’ “Em” D ”HER ,
`h .z..c.‘:..“¢r-r~IzIGI‘°’%.BG5.05:2. wring.) 1-
`
`
`“L.’ .5le33: I:..:.3.1.4 0535.33? 1E5}:
`APPLICANT CERTIFICATION
`' '
`
`; 1.“: H ”\ 3.... 3-.. -. ,. : -
`
`
`
`
`-~-n.u.-~zr.~:_.a;'—| I u,hm; L
`‘
`-'
`
`nflEfiEBVCERTIFVTHATTl-IEVEHIOLENESSELTOEE‘I‘ITLEDWILLNOTBEOPEHATEDUPHNTHEFUBIJCMGIWIAVSII‘VATERWAYSOFWSSTATE.
`
`
`
`h l .‘ I V l
`.
`
`'—1CmFYmeECEflTIFICATEOF'flTLEISLOSTORDSTROYE).
`fr ' *'
`‘
`‘
`I CERTIFYTHATTHIS MOTOR VEHIa-ENESSE.WAS REPOSSESSEDUPON DEFAULTCFTNELIEN INSI'RUMMANDIS NDWINMVFDSSESSION
`
`IIWE HEREBY CERI'IFYTHATIIWELAWFIILLVOWN‘l'I-IEABOVEDESCRIEED VEHICLE/VESSEL. AND L’NCEAFPLICATIONEOR‘MLEIFxXEN“ISRENE REWRDED “(mails HEREBYGIVENTHATYMEREISM
`
`
`t: ‘~‘:.~_L':"_::~r«. _4.0.,” .......
`--.‘.
`
`
`EOS‘IINGWHnTENLIENlNEmUhlENTINVOLI/mflWWDESCRIBEDAEOVEAND‘HELD BYuENI-IQLDERSHOWILAEOVEIIWE FURTHERDGRETODEFENDTHETITLEAGNNSI' ALLCLAIMS.
`UNDER FM‘IIES0FPEBIURV.I DECLARETHATI HAVE READTHEFDREGOING Dow'IIEm'ANDTHAT‘nIEFilmsSKATE]:1" ITARE‘IBUE
`
`
`
`SIgnaIl-lm ofAppfmnI/Owner
`Signature 0! Appfimnvco-Owner
`HSMV82041 REVISED 02’06
`
`
`
`
`
`
`
`
`
`
`

`

`02 04 15
`
` 1. Maureen Johnson, Chief. Bureau of Records, Divisinn
`
`of Molorisr Services, Department of Highway Safely a: .d
`Motor Vehickss of the State of Fior’rda. do hereby earth?
`that this Is a true and correct stay offlre mater which r '
`driver license record from tho otficia! mwrds on fit: in t?» .‘
`department.
`
`

`

`02 O4 15
`
`SCAN TRANSACTION NUMBER
`
`168267517
`
`\
`{2
`-.‘5
`£55
`
`m:
`
`\ N97
`725.2%mgr.
`:1
`2aw
`~59»?
`«w
`"7‘5;
`A?
`
`.c(..3.
`
`63‘:.
`
`AV
`
`ir
`
`HA
`,.F
`”3%
`
`JE
`
`“:
`
`‘A5
`(HUN.
`.I
`grinF
`figs/F
`‘3'
`13501131;
`o
`11am
`E?
`
`El!
`R
`3:33:
`
`2
`
`«L
`{f
`
`E D
`1‘
`F5
`a?)
`
`g e
`
`ru
`59‘‘1.\~-
`
`ll
`'E
`52%;:
`
`vh-
`van/(KN
`53m}?
`
`
`
`
`
`
`
`..
`.1:
`W5
`.5.oz
`
`‘37:.2.
`
`taxi.»1
`
`M35
`
`:39,2
`.v{56.
`
` .95....a&..3»?va
`»aI:1“;R;
`“cam$3.
`
`“3.94
`
`2%.;.
`
`3:1...
`
`:5
`
`o9,as.».~.
`v.5..~\........&.
`
`xx.
`
`f:9‘" ‘v-
`{'i’
`
`a
`1,
`v .
`o.\ ”A “’5 _
`
`5',~
`”L
`‘1 "5
`
`3...iI;Ya?.6
`h/Axhz...
`
`as:it,«(3%».
`
`
`
`.c:)5:
`
`2.2:.
`
`I
`usl
`u
`elect al
`0!v
`\ne um
`\
`a
`V
`99 cqrnpl
`19‘"1156ch WI
`m
`[Ind
`\
`a gem
`n;price
`'Hc;
`lea;
`'
`flu
`e. pgmh
`.«
`an}?n
`SHERRI!m:
`Ingafab:
`mull m finehnd/o "
`I“:6MIN
`r(minim:
`“$151.54,
`5'
`15mph
`u"‘9
`10: 0
`loridnc!
`Eu:cemfimz:
`r!on
`f
`a crust] d
`a,“
`E‘qntbe
`” 2:
`x
`6
`”‘5
`a"
`:32?
`$493 ’2:
`‘1';
`,"o? -
`j
`.,..
`\
`s
`§
`m
`w5
`an
`mi
`”3:71:33 ' :1 .
`in;
`I”.
`1min)
`(
`hem
`B0
`3:'1
`y
`{y
`5
`‘
`l
`\
`\
`-
`til!
`2
`E";
`(v2.
`}
`Zro'l
`'yf
`ua
`AN!
`;
`LIMITS
`ACI
`¥
`AL
`Exv
`cfi
`SJ
`i
`TE,
`9?N6 DOC
`*‘i
`IE!
`F‘3?!
`’IE
`MILEA
`5H
`3;
`EM)THE'FOHEGD!
`\
`50!,.
`IIENT ANDT
`IN IT ARE
`CTS STATED
`..
`m
`
` \«V-.\TEE
`331%:
`58‘
`56*:
`‘x‘.
`..
`.. w .,
`,
`3
`‘z
`a".
`mi 2
`
`a
`
`; *
`
`fthe:
`lxlggiiyr are‘
`”m???”
`K“
`:3
`:5
`’
`‘
`K
`‘ 2E?)
`
`DI
`
`\Vt uvv . .x
`.5)?“
`.x/
`2:;
`I
`i
`1%
`
`’lk
`
`(
`
`M5p
`I.
`.‘5
`$
`
`,4
`53 w-
`
`b
`J
`'wv
`it
`12...?
`
`1
`
`El
`F1
`(:0
`.EGJM
`
`.1.
`
`‘fau‘5—in.
`I.“
`:L
`
` ‘. Itat.Ar
`,J‘t v 5
`.n
`1'4 h-
`1
`a...
`V 1 fi' “.
`I:
`‘
`
`u
`
`4 r u‘
`
`v-
`
`l
`
`bl
`
`\‘i
`
`'5
`
`x."
`
`:r'
`.in
`f‘
`
`Haas:
`N
`A1);
`
`=1};9 1r.
`
`
`5.9xn‘2»)?
`ivdRXLag».
`.5.»).z
`
`
`
`>5an.3ekYfiwZon
`
`ever.‘Rafi;
`
`
`

`

`
`02 04 15
`
`I. Maureen Johnson. Chief, Bureau of Records. Dhrr’sic.n
`ofMotorist Services, Department ofHighway Safety 2».j.
`Motor ‘lehr‘a'os ofthe State cfFlorida, do hereby canny
`that this Is a true andcorrect copy oftha mars; which or
`driverticense record from ma official macros on fire in t,
`its
`department
`
`

`

`02 O4 15
`
`SCAN TRANSACTION NUMBER
`
`168267518
`
`may ”1149"“!
`;
`-
`A
`w vi wémfx‘g‘w
`9‘
`I.
`Jr'l" V». r
`'
`1’
`‘
`. 5-5 »
`‘
`I
`l
`,9»;
`_,
`,:
`EQE
`.,.z w .
`R‘u’hp ‘ ,,. u
`a
`@omm’gég
`rfl-
`«,
`.31;
`‘.‘,,‘,Vn.
`2.1.3.
`(«aw
`” a
`a ’ I; - fl¢ F
`< =II nwtqmaficwn
`x. v}:
`z‘iflfifigfiohis xv. EASE
`‘ a)? l.
`‘szcrssqrmmnmcuuum
`r,c
`aw ‘.
`'
`'jAm- m x ngal‘rgnoumplsy
`00-va him!
`Slpl Hm.
`
`.
`
`i!
`$r~¢
`mo‘
`
`a
`
`\
`
`n
`.
`A
`fi"1“."./~V~
`mus: ~ J
`in:
`‘
`Vr
`
`filter/Aéqulml
`Sm: Ha}:
`
`_
`
`3W
`
`
`
`
`
`ISECONDWWWBYLICQSEJDEALHZ
`
`‘7‘
`
`ScltlgDulq‘l
`[June If”
`'
`L
`san v'ugx'suam:
`_
`fighi‘l‘e“! Nam-(u):
`E STATE
`1
`
`I
`.
`_ .
`CAUTION: nun cum»?-
`y_
`.
`. $3 ‘
`
`
`
`
`
`
`:
`
`a
`
`. 'an Hate.
`Amt?» mm mm «pacific».
`
`. Auction Lm Nugnbcn
`
`‘.:‘_ .
`‘2 3.32m 1 Enemy
`~
`K.a .
`lfiOiENzfliS‘)MILES‘bA{'EREAD * :57
`q
`...
`.
`.
`.
`,
`\
`A
`Q ..
`.i‘ 1
`v
`campynun- ro THE BBT'DF Qty KNOWLEDGE 13:5 Mme: READRtG. \
`33 IS NOTTHE ACNALMILEAOE.
`. . 'axcass or rrs MECHANICALLIMITS
`E 2 '1s In excess or as MECHANICAL Lmrrs
`AFEIJES 10: man- 000mg“)
`‘
`' Co-anhuurMnn‘
`.
`. Sip: Hue
`‘
`PnancrL
`
`'
`'
`
`Iéucflun Mgwhiupumuy
`‘
`'
`‘P‘w ‘17“
`
`"
`
`‘
`
`.
`
`THATIBIS [3,: on B- " ‘. s -
`
`
`
`n
`'
`v
`'
`
`
`smal'rommmmw. ‘ €
`.
`x
`.
`.
`.H
`_
`A 5"
`‘
`. \ A
`, x
`_
`,9)
`, D I. REFLECI'SACTUAL MILEAGE"
`,
`‘_
`‘-
`
` "
`
`N.“
`
`,1
`'
`(NOTENTHS)MILES.DA
`came! 11m to THE BEST or- wxrgomgmam 913934st many 7‘
`.
`.rfllpynim.‘ “a‘
`_3 fisummgcmakulwaa
`1‘
`.
`"35):; acgss or rrs fitfafimmflmirs’
`,?
`4
`"~\
`gaxcsss 0E1“ magmmmmqrsf s“
`9 ‘wmgmgsd ODOMETEEQECREKAfiQYgfiV
`, :muss 1o manomnmaasn ‘«
`JD; ‘.
`,, ..
`. .
`, ..
`-
`
`r, say“ heifer-1
`Hm:
`‘ ’
`
`
`
`B Z’mirODCMEMN631! '
`4‘.
`(at)
`‘1
`.
`-- “‘0 if?
`é
`.
`_
`.
`.
`;1 mLagstnyngA
`
`u
`
`anfbuz-k Nuneo):
`n .
`WE 5+§TE Tum-1195 El 5 6x
`.- .
`x
`-.
`U‘flOfl: MCARLFULLY ’
`“A
`, sgrdm: yolié
`
`.‘4"‘
`
`.~..‘
`
`YucmsapDEM-ER
`magma
`
`Mass.
`fin,
`
`Wham 'EMIS‘h'HLWMQ‘Jfi13.34.! ISw-.:».L€.->T"
`.
`'l 0" (I.
`l
`'
`$rmufi
`inmmn
`‘
`’
`I ,4 m s pm
`».,,
`.
`.
`,
`-
`..
`Imaufl'n‘: a- 11.2,:
`.
`a.
`I. m.U' ; E.) Namath .
`'(«.-L--
`E’..oz.L-r3mf.:'3.'5« «'meA.“
`>‘-
`'
`.4
`:H Hg...‘ ,rrun-u
`-
`l
`‘.
`'
`~.
`.3
`.
`. u .1 1. m.
`1:.
`.'u
`1'v‘
`
`__.;___ _.
`
`‘
`
`.
`
`

`

`
`02 04 15
`
`!. Maureen Johnson. Chief. Bureau ofRecords. Division
`0? Motorist Services, Deparimant of Highway Safety and
`Motor Vehicles of the Staie of Florida. do hereby cemiy
`that this is a true an: can-:32”: may cf iw3 main! Mic! .- o’
`dziver iicensa mead from 35$: official recs: 9 an in;- in it?
`(199an
`
`flaw—W
`
`
`
`

`

`02 O4 15
`
`we
`SCAN TRANSACTION NUMBER
`
`1 6 8 2 6 7 5 l 9
`
`
`'1
`
`‘-
`STATE OF FLOMDA
`LES- DIVISION OF MOTORVEHICLES'
`oeenamam OF HIGHWAY SAFETY AND MOTOR VEHIC
`FLEZJSS-OEIO
`uemmnxmn BUIUJING-TALLAHASSEE,
`l REGISTRATION
`FOR CERTIFICATE OF TITLE WITH/WITH
`MOTOR VEHICLE
`NSFER
`D MOEILEHOME EVESSEL
`:VEHIGLE TYPE: CI OFF-HIGHWAY VEI'IIOLE
`nw ERIA'PLICA l INFORMATION
`Fuel Nnmhnr
`l wn‘lr
`I10
`yes III
`Are ynu a Florida IIsIdanI? Dyes Una
`Dye: Elna
`m you an aim?
`Elves
`no
`en Issued. Ifneilller lInxls checked. “I: We will be
`Issued with 'and.‘
`
`NOTE: When Jan-II uvmershlp.‘ pleas: IndImIe if "or" or 'and'"Is In heshawn on We VIII
`I on IAND
`Owners CounIy of Resldenae:
`Ifappl‘cible. I] ure aIaIeIIIemaI-ndér Pusan El Tenancy ay the Emmy CI Wnlh Inshls or sworship
`Name As llAquars on Dr
`Dan:8cfEII‘III
`EW—
`-UeenseIF'ItsLName.FullMlddIeIMaIdenName.LzslName)
`SWIJII
`L o
`Dale OfEWI
`.
`11‘
`I ;
`are Name A: ll Ap-ears III-I DIiveI'License (Fusl Nam2. Fun Mddlemtaldm Nam. Lest Meme)
`
`Unil Number
`
`mD
`
`
`e orFEIDISuHIx7MB? _Q 0
`SaxF FLFLDtlve:UtenseerFEIDISu7lfixNumber
`
`fl
`
`APPLICATI
`APPLICATION TYPE: E] ORIGINAL
`:-
`BummerNumber
`
`Lessee'sFusl Name, Full MIddleIMaIIIen Name. Lasl Name
`
`Date DI Em‘
`
`Dwnm 5 Main; AddresslMandalnry)
`
`
`
` CW
`“1033 NW. 285%
`
`
`
`Ih'OWIIel‘s DI‘ Levees Malfing Address (Mandalurfl
`
`ERFLUnverLicenseorFEIDISIIII'O:Number
`
`Owner's orLessee's Pnysuxd SlmalAddIus In Honda (Mandainry)
`
`m_
`Slale
`lfip
`Phyelea Addlcss ofMobile Home(it applIeeble) Checkmma mom“:hemennhlpn-mIwith In HI’MIEIIILE a
`
`
`61y
`
`Mal Tu OuslumerAfldllss (llIfilfueI-II me Above Malfing Address)
`
`VehldeNussel ldeIIIIlicaIImNumIIe:
`
`MOTOR
`
`HIE
`
`SC' IPTION
`Flandn Tull: Number
`LE MOBILE HOI " DR VESSEL DE
`Mak
`anufaelurer
`
`-VAN USE. IF APPUI'ABLE
`Year
`GVWILOC
`BHFOICGQ
`bungm
`I
`302024513
`NUIALIIDWM
`Frewws Slaln-
`name: File uVmel mmlimr'mnlIer
`I] Pessmsek'
`Cl OTHER
`mmasVESSa.
`'
`FUEL
`_
`7' 3 H:
`In.
`PROPULSION
`HULL MATERIAL
`m5
`(71": deg") IIIwafer;
`El saII
`El Oulbosrd
`vessel draws)
`U Aluminum
`El DIE»
`Molorheal El Houseboal El PersonaleleInrafl El Wood
`’D AirFmpeIled
`U’ Inboard
`1:] Sleel
`El Canoe
`D FIIIEIQIVS
`FT.
`IN.
`U Dab’mMelarbnal I] Panlunn
`[I InboudIOuIbaard
`'Fwal vessI-Jk Zs'muoreIn
`D other
`I] WoodlrI—nenglass
`E} AuxI'IaIysmoaI El Airbual
`D o
`lenulhands!maels-
`amber
`‘
`Spea‘Ijv
`Speedy
`PREVIOUS
`LTImtgbre
`I] 5:3th
`use usveessL ‘
`OUT-OF-STATE RE§I5TRATION
`E] CumeIfie! SIIIne CIgb
`NUMBER:
`|'_’l Ben-meme!Shn'mp Rec’p.
`El CammErCIaI SIIII'mp Men-Reap.
`D Cdmmercifl SpineyLobsler
`
`.
`
`Speedy
`
`El Gunmemlalfilue Cal:
`El Reanuunal (Pleasure)
`El 051%;me [I CommunalFIsII El CummaaILIIesaII
`[I Exempl
`L_J “fill-WWI
`E1 CommeIcIaIMadIeIaI
`
`M
`U Conunexclel Sponge
`D Govemnlenl
`a Commercial Cherie- U Ccmmem'eJ 0qu
`U Commercial Dysler
`
`‘
`
`Slzle al Fancipal Ilsa
`
`.
`
`
`
`PIewinustFedeIelly DawInanled‘Vessel,AlIachCopy ol:
`1:!
`E-
`DSHDRT‘IERM u-znse
`Dassemafen FROM PARTS
`CHEEK IF
`err cu'srorAER [I
`LlanholdafsAdams
`’75‘4 mp
`n: I‘‘ h v
`nu.
`Illsm'olcrIIehidaerInnbfle'name We loyié owner:Hickbuicand enunleIsia'
`lfLIenIxIlIlerauIlIoIizes menepadmnlla sand
`y-u... . u...”
`”a". h» «v. .I
`a ..(S'gnaIura affimfinlder‘s Represenlalve)
`lVIIBoesnoIamIIy Iawssels). II hamsnolchenked We will Izémailer! In lhe firsl Tenhnlder. ,l.’
`THEVEHOLHOELEHDIJEDHVESSEAWUEED?
`’0' EISI'IIFIIASWNSFERKED.HWANDWHBIWAS
`RE'DSEESSIOH
`Elmumomen
`.u [Jonammm
`. .
`I _
`2....»
`‘I
`
`
`SIIII in nae; nrimpfisnnmenx.
`
`
`WARNING:Federal and Slate Iawrequlres lha.yousIale
`-_..J _, AND TO THE
`féIenrprw-dingafalsestatement?!
`IT
`'cITIuFaIIuvelcwmp
`I112mfies‘ge'Incomedian"WIIEI'"an‘appréflbferamtam
`Momma MILES me READ
`DIGITODDMETERNOWREADSE]
`ISTA‘I‘Enun nus MOTORvenues III 5 menDR
`EESTOF MY KNOWLEDGEWT |T REFLEGTS THEACTU‘IL
`meme IIIEALIOLIMTOFmcexINEXEESS nerrs Mgéflfllfi! ”an
`D 1 HEREBYCSII—IIF'I TIIAT.TOTHE BESTOFMYICHDWLEJGE. THE UDOMEI‘EH READING
`CAUTION'
`DDh‘oTCHEBfi
`
`WARNING— ODOMEIER DISCREPANCY
`[FAL‘I'UAL M EAGE
`D ZIHEIEBI’CERI‘IFIT‘I‘IATTMEDOGIETERREADING l5 NOTTHEAETIIAL IIIILMGE.
`
`
`’ DEALERSALES TAX REFORTAND VEHICLE TRAD IN INFDRIIMTION IF APPLICAB
`DEALER UCENSENUMBEL
`DATEflF SALE
`
`FLDITIDASALESTAX REGISTRATIDN NUMEER
`
`
`_GENTSIGNAWREDEALERT
`moUNTOFTAX
`VBIICLEIDENT‘IFICATIDNNUMBER0FTRADE1—H
`
`
`
`TITLE NUMBER OFTRADER” KNOWN)
`VEAROFTMDE IN
`WEDFIWEIN
`
`
`www.llhsmvgnv
`
`
`""———'—""'"—"'—"w
`
`El Oapynrmceeé mummmnwi Papers
`BRANDS USAGE AND TYPE Check Auulfcable 3045)
`
`DPOUCEVEHICLE
`[33$er
`UFACTURER'SBUY E'ACK
`en
`Usuaeqm
`EIKITCAR
`'- Vchung-u DaanIUI-JI
`Lafiflji
`
`[lone TERMEASE
`ljneeuce
`
`DEECTRICVEI-IICLE
`
`MILEAGEOFTHEVEHICLEDESCRIBEDINTHmgaéDOCUMENT.UNLESSDNEuFTI-LEFOLLOWINGIscueczeo;
`
`
`
`

`

`02 04 15
`
` r. Maureen Johnson. Chief, Bureau of Records. DivlsIon
`
`of Motorist Sen-ms. Department of l .ighwa" Safety and
`Motsr Vehicles of (ha Siste of Frarida, d;- hzrciay Bria-'3‘
`thatthis is a true and correct oar-y of {he mciorvzhicle- n."
`driver Incense record from the official records on file in (hid
`department.
`
`Wag.
`
`

`

`02 04 15
`
`.
`SCANTRANSACTION NUMDER
`
`_
`1 6 82 6 7 5 2 O
`
`.
`
`’
`
`
`
`s sac-nunnsoucassA PHYSICAL msPEG-nonAm:AvauncxnauOFTn‘sval-no.2IDEN'I'IFICATIUNwuaencam('cu'zpillsMoxauuuiaanmi um:I:gauch.___._S"AWFAHURED
`
`ERIgfl Tu 1:53 DFTHE MOTORVEHICLEDESCRIEED ON THIS FORM 5‘! A LICENSED DEALER. FLORIDANOTARY F BUG. FOLIO OFFICER. 0R FLOBIDA DIVISION or MOTOR VE'IIQES
`ovraF 51'an MD on v H c
`DEAL
`THeuEHII-‘IEATI N uusf sé suaum‘eu cut-ma
`Enuau
`‘
`EMPLOYEE OR TAX COLLECTOR EMPLOYEE.
`TH VIN IS VERIFIED
`SrA‘I‘IDNERY. COMPLETETHIS SECTION ON ALLUSED‘HDTOR VENEES. INRUDINGTMLERS. (WTI'HABBREVIATION OF 'I'L‘ WITHAWEIGHT OF {nun POUNDS ORMOREI'NOTWRRENTLY
`TITLED INFLOHIOA.
`_
`I. III: undalslgned. wrflyIIIaI l have physhlly Inspecled me abavedesn'ibedvefldeand find Im'vehieh ueuullqlbnmmr In her
`' ___.._.___._.'
`-
`.
`’
`mm. Wlmfigfln umcn K
`
`'
`PRINTED NAME
`'
`'
`DATE
`,
`
`'
`Badges nrFlufida Dealgr
`lawEnforcemenlOlficn IIIFlorianDedel’éNam:
`
`Fluid: Gnmphm Emm'nuI‘InspadBrfladgeor II) Numbar________.._.
`ELUMVIIachIIadoI any;
`.
`I
`
`CGLIMSSIOEQ "1’1:OF Elma"OT‘RV:
`.
`mm
`
`: m
`
`SIGNATURE
`
`.
`
`WWSlarfip oESul
`.
`
`'
`SALES-TAX EXEMPTION CERTIFICATION
`”
`[-
`THE NEG-PsiOFAHSCIIEATIDHALVEKCLE TOEEOFFW FOE RENTAS UVINGACCOMMDDATIONS DOESNOTDUMP! FOR EXEMPTION. I CERTIFYTHERECRQDOIMLVEIICLE. MOBILE IIU
`
`SEENMCI-MSEDAIIDISWmmnESuflTAXMPOSEEYmZEFLORMsYATUTB.“.
`'
`'
`'
`.
`CONSUMERSWE0F EXEMPTIONNUMEFJI.
`
`I] Pmousmgswsma-cafismwflaéizrq msvmn mm» CERTIFICATE
`
`‘
`
`'
`
`me an vassa.oescmasn nu:
`
`I] Hummus. E] upeILEI-ms [I vsssavauasusafi‘am'nswavmamrm
`
`
`
`- -—' _' wsuxnsammmnuumm
`..
`‘
`I hereby nnlfy Ihal warship}![hemolarnhlde. mobda'home orvassnl desnn‘bzd on this applfralfun, Is nu!subjectIn Flgn’n‘a Salas and UseTax Iothe Mowing masoII: U MERIT-NICE D 51"
`I] DIL’OITCS DEGREE D TRANSFER EE‘MEEN HUSBAND AND WIFE a EVENTRADE OR TRADEDOWN [gala the I‘d-cl: Nth: uven Ind! Dr uni: dawn and III: Innsferar Informalinn. including
`III: Innsl'gmr‘s name and addIess. belaw under "other: Explain"!
`
` I
`
`.
`
`.
`
`.
`
`‘
`
`.
`
`‘
`
`'
`
`.
`
`-
`
`.
`
`.
`
`-
`
`‘
`
`'
`Dale
`
`.
`
`
`
`~
`
`.
`
`‘
`
`_
`
`'
`
`.
`
`'.
`
`
`
`Domes: lawn
`.
`.
`-
`.
`.
`.
`.
`
`IF-
`_
`-
`REpuss*SSIDN DECLARATION
`'
`-
`'
`IF CHECKED. THEFOLLOWING gmncmansmsma 5911-15APPLICANT:
`_
`I
`'
`I
`ms Mowwm PQSSESfilo'N -
`D l‘CEflfiFYTHATTHIS MOTOR VEHICLE. MOEILEHOME OF! VESSELWAS REPOSSESSED UPON DEFAULTIN'I’HETERMS OFTHE LIB! msm'uuamm
`D (VE§SB.3 A FHOTOCOPYOF THE LIEN INSTRUMENT FOR THE VESSEL I5 REDUIHED AND ATTADHED.
`mus IREPassEséIqN).
`[AM REDUESTNGTI‘IAIAN ORIGIN-AL CETIFICAT'E OFREPOSSESSION EEISSUEDFORTHEMOTOR VEHICLE OR MOBILEHOMEIN LIEU OF A
`0 MM REDUESTNGTHATA DUFUCATE CERTIFICATE OF REFDS§ESSIDN BE ISSUBJ FORTHEMOTORVEHICLE DR MOBIL“.HUME. AS THEORISIMHAS BEEN LD-EI' DR DESTROYED.
`,
`nun-I155 am: OWE! can-nammnsr
`Is awaysFOLLOWING cenmcmons ARE MADE EYT'IIE'AFFIJCANT:
`‘
`_
`'
`D I CERTIFYTHATTIIECERTIFICATEOFTI'ITEIS LOSI' OR DESTRDYE).
`D THEVEHICLE IDENI'IFIEDWIILNO'I’BE OPERATED ON THE STREEISAND HIGHWAYSDFTI'IIS STATE UNTILFEDPERLY REGISTERED.
`D THEVESSELIDENTIFIEDWILL NOTBE OPERATED ONTHE WATER5 DFTHIS STATEUNTIL PROFETLYREGISTERED
`.
`El mammal
`'
`'
`‘
`7
`.
`IF-
`AFFIJEATIOH ATI'ESI'MENT’AND mammna
`IIWE PHYSICALLYINSPECTED THE000MEI'ERNINANDFURTHERAGREE TO DEFENDTHETMAGAIIQSTALLWIMS _ (More Dual! one form HSMV 82040 'may be used [or addlllonal
`s‘gnatums.)
`. ‘
`_
`I
`_
`_
`_
`.
`VE READ THE FOREGOING DOCUMENT AND‘THAT THE FACTS STATED IN IT ARE TRUE.
`’
`.
`/ ‘
`’.
`A SIGNATUREcr-APPLICANT(mama)
`REIEAEEDFSFDUSSOR HEIRSINTERESI'
`
`-
`
`'
`
`If.
`
`The undelsignerlpersonIg'IslalsXs) as Iallaws'ThaI
`_
`
`-
`
`'
`
`.
`
`'
`
`A
`
`‘
`'
`I
`.
`.
`I ,
`‘
`' I,
`..
`.
`r :.(NamenfDeceased)
`-
`-
`I: ”J! ,v
`I‘. -I: at»: an ".1 J .'._..«.--;. . \ I“, .1 I
`
`.
`D IE'slale (wllh a wlll)
`. E]. Inlesgafe (yimgtllg wIIIlgnd Igfl III; . mvipg pgngfidgriegnaglen l‘mlow.
`CI VWIen applicable, III-z heirs (named below) newlyIhal the cérufiéqlééffilIgIflo‘pl'ur églfoi'éi‘l.“ ' ‘5'; f“ f:32'; F123.”1‘ ,:.
`,
`signalureIs) ofsurvivlng spouse. cmqwner andlar thrs. (Mq're,thanjun; Ionn
`S_MV figngayhe’use‘d for gdylvsggr élggglures.) '
`UNDER PENALTIES OF FERJURY, I DECLARE THAT I HAVE READ THE: FOREGOING DOCUI-IENTAND THAT THE FACT-'5 STATED IN IT ARE TRUE.
`PrintorType Name a!Spous=. Co-pwnu fir Hélfls)
`‘
`.
`‘
`'
`' “
`2
`SIg'nauIIé uf‘Spous=,Cn«OwneIorfluids)
`
`-
`‘
`.
`'
`I ———'
`. —_—_;"__-_'I‘__—___________'_I_—_ '
`R
`v
`a.
`1‘ ~ _.-
`'
`.
`.
`u." "a.
`'3... .4:z......“.'... 3...... ,5 ,
`-
`‘
`='
`'
`"
`A
`I
`v"
`""‘ “"‘p{‘1 how...
`“—‘————"“-——-——-—-——4—'—"
`A
`’
`'
`_'____.___.___‘_'____ _
`'Ila' II he me nIdeath In:deudenl ms Irma:al themmvehlde, mania name clvessel Ilesmbzd in swunni nIlhls loan. Thai III! uslalals ml mdzbled and III: asselsol the eslale. 21de Ihls mnlnwghzsg
`mun:hone or vessel an: sNI'tiax-II Inpay allius: mintsgndIlsal nowhale pmceldhgshav: hamlnslflulw upon III: ulalc. TM III: peismls) .sfgni-g new: Imeby Muses all Inuit rial-I. IIIIe.InlyusI and find an
`‘ he's :I12w.leg:lees. mine. or nuxemis: Io Ilua 3.515;!de wish. mobile hum: nr #5:! In:
`.
`'
`.
`
`' fi—W— ~
`‘
`‘
`Name oiAppIInanI[s) (PIIIII or Type)
`I'
`‘
`RESIDENTS n“ I'LORIDA AND ALL VESSEL OWNERS. RESIDING IN FLORIDA OR OUT OF STATE, SEOULD SUBMITTHIS FORM AND ALL fi‘EDUIRED DOCUMENTATION To A LOCAL FLOFII’A TAX
`COLLEESOS'S OFFICE OR THE FLORIDATQJ‘COLLSETUR‘S OFFICE LDCA‘I‘ED‘INTHEAFPLICAN‘I‘S scum OF RESIDENCE EUR PROCESSING.
`.
`I
`_
`.
`‘
`www nhsmv.guv -
`HSIIIV 32w (REV. 02”!) S
`
`died on
`
`I
`
`-
`
`_
`
`.
`
`(Dale)
`
`'
`,
`
`.
`
`'
`
`.
`
`.
`
`_
`
`-
`
`'
`
`‘
`
`' u
`
`'
`
`-
`
`-
`
`‘
`
`‘
`
`.
`
`_
`
`_
`
`.
`
`~—
`
`.
`
`.
`
`1‘
`
`_
`_
`
`.
`
`‘
`
`'
`
`'
`
`

`

`
`02 04 15
`
`I. Maureen Johnson. Chief. Bureau of Records. Dlesion
`of Motorist Servim. Depmment of Highway Safety arr:
`Motor Vehicles of the Siala of Ftcrida, do hereby certir;
`
`that this Is a true and 0:73"! my o‘t‘u mew mini“: r:
`
`driver l’censa reccrd from {1‘39 official rewards on Ms .. i as
`depadmsnt
`
`W
`
`

`

`02 O4 15
`
`SCAN TRANSACTION NUMB_ER
`
`161811379
`
`CNTVII AGVII SUM fiFTII
`
`TRANSACTION ID'S
`
`TITLE NUMBER
`
`VEHICLENESSELIDENTIFICATION Ii
`
`VEHICLECOLOR WTILENGTH
`
`IIIIIIRIIIII'I‘IIIII.IEIIIIIIIIIII
`STATE OFFLORIDA
`APPLICATION FOR VEHICLE'VESSEL
`CERTIFICATE OF TITLE,
`MAKE or
`BODY
`YE. MAKE
`MANUFACWRER
`
`N 1073462
`~Tn
`649480455
`an
`659381
`
`VW
`[LOG
`
`G
`
`|:]
`
`VESSEL
`
`FLNUMBER
`
`slgnaluve a! Appllwnlfcoomer
`
`
`_5747729 —N4AL11DO6N390859—-FUEL-NISS--E-
`
`
`D-ATEDFISSUETRANS
`
`MO DAY YEAH
`
`CODE
`
`VEHICLE USE
`
`HULL
`MATERIAL
`
`PROPULSION
`
`BIRTHDATE
`SEX MO. DAY YEAH
`
`RESIDENT
`ALIEN HES”
`
`Y
`
`Emma
`IslOWNER FUDLfi 0H
`and OWNER FUDLE OR
`RE I DJ!
`UNITIi
`
`AGENCY
`FEE
`
`TI'ILE FEE
`
`SALES TAX
`
`GRAND TOTAL
`
`--
`
`Applicamlowners Name :1 Address
`REEL AUTO REPAIR INC
`Clo PROFESSIONAL LIBN & TITLE SERVICE CORP
`[0544 NW 26 STREET #EIOZ
`MIAMI, FL 33172
`
`VOLUNTAfiY CONTRIBUTIONS
`
`Action Requested: TRANSFERTITIE
`
`DATEACQUIFIED
`12/23/2010
`
`LIENJNFORMA‘IION
`NAME OF FIRST UENHDLDEH:
`
`ADDRESS
`
`DATE OF LIEN
`
`SELLER mFORMA'I'ION
`NAME OF SELLER. mm DEALER. on OTHER PREVIOUS OWNER
`ADDRESS
`
`DEALER UCENSE NO.
`
`ODOMEI’EFII VESSEL MANUFACTURER
`13,333 MILES 12/23/2010 ACTUAL
`RECEIVED DATE
`
`FEID II OR FLI DLAND SEXAND DATE OFBIRTH
`
`ODOMETEB
`DECLARATION
`CERTIFICATION
`
`El
`
`DMV ADQOUNT If
`
`SALVAGEWEE
`
`CONSUMER OH SALES TAX BEMPTIDN II
`
`INDICATETOTAL PURCHASE PRIDE, INCLUDING ANY
`UNPAID BALANCE DUE SELLER, BANK OR 0THE98
`
`3
`
`0 ()0
`
`El gamma macs: VERIFIED
`
`SALES TAX AND USE REPORT
`TRANSFER OF TITLE III
`PURCHASER HOLDS VALID
`. EINDICATE SALES OR USETAX DUE AS PROVIDED BY CHAPTER 5
`IS Bum-T mom .
`‘
`EmTz'o'N‘ céngxgibnmw
`FLORIDA SALES on III
`.md':3.Im."n.212,FionloAsrAIuIEsA 1
`VEHTCLE IA -'V'ESSEL SWELL. BE
`use: TAX FOR THE:
`"F"?"-' ”DE-{13,-a'FhfiIfiM'1!;
`OTHER"
`ul'v'l
`USED nxcqvé'mim ’E'dR' 'RE:_N"IEAL
`amasoms) CHECKED CI
`.I
`1
`..:l
`”.0... “I1.
`- .
`. .mu
`
`APPLICANT CERTIFICATION
`
`anl 4'“:
`
`WEHEREDYcEfiTlFV‘I'HATTHEVEHICLENESSELTOBETITLEDWILL NOT BEOPEHATED UPONTHE PUBLICHIGHWAYSIINATEHIEAVS OF THISSTATE.
`\n.
`ICEHTIFY'IHA‘I’THECERHFICATEDFWLE ISLOST ORDELS'I’HD‘IEDé‘
`VE. an»:
`'-
`I ma: THATTHIS 1.1mm!VEHGLHVESSELWASREPOSSESSED UPONDEFAULTOF‘IH'ELIE"INSTHHE‘ENTQNDSNOWINMV PUSSBSIDN.
`W—JE-HEREBYGEH'HFY'I'I-IATIIWE LAWFULLV OWNTHE ABOVEDEEMEDVEHIufilVESSEL':RIDMAKEAFPUOATIONFORTITLE IELIENIS BEING fiEDuRDED NOTICEIS HER-V BIVENTHATTHEREIsAN
`BOEINGman-ratHENINSTBU'AENHWDLVIHGTHEVEHICLEIVESEL DESCRIBEDASDVE AND HELDBY LIENHOLDERSHOWN ABOVEIIWEFURTHER AGREE ToDEFEND THE‘ITTLE AGAINST“CLAIMS.
`UNDER PENALTIES DF FWUHV. I DEDLAHETHATIHAVEREADTHE FOREGOING DowMENI'ANDflMTTHEFACTSHATE? IN I'I’AHETWJE.
`
`.
`
`Ms
`
`HSMV 82041 REVISED 02/96
`
`ignalura oi ApplimnllOwnar
`
`

`

`
`02 04 15
`
`i. Maureen Johnson. Chief. Bureau of Remus. Division
`of Moiorisi Services. Department of Highway Safety and
`Motor Vehicles of the State of Fit-72:53. cia hereby cerilfy
`that ihis is a bus and correct copy sf the motor vehicle or
`driver license record from tha oificia! nacords on file in his
`depanmeni.
`
`flag-22AM
`
`

`

`02 404 15
`
`SCANTRANSACTION NUMBER.
`
`1 61 8 11 3 8 2
`
`PBBV-IIEH
`"MI". [IE I IIIIE IB’IIIE mi
`ASAGHITFDH THEUHVGH
`*10544 Immsm 051105.302. Dufl. Fla-1172*
`(305) 592-6090
`
`CASE NO. 23057
`
`11/29/2010
`
`,
`
`NOTICE OF SALE OF MOTOR VEHICLE
`TO SATISFY POSSESSORY LIEN
`MIMOFUHJNOHG
`(c
`_
`'
`E)
`-
`CUSTOMER: WILKINSON EUGENE
`
`'
`
`To: REGISTERED OWNER
`RU'PERT IBENA RASHAMA
`
`1070 NE 163KB 51' APT 10
`.
`
`"A“
`ADFRESS:
`N MIAMI SCI-I
`CITY:
`ISTATE, 2mg;
`3 31 52
`LIENHOLDER AND/DR OTHER Eeasans cLAIMING
`AM INTEnEsT m on MEN mum THE VEHICLE
`N
`NISSAN MOTOR ACCEPTANCE CORP
`AME:
`
`Aunness: PO BOX 254548
`Cm:
`SACRAMENTO
`.
`95865
`
`SATE.ZIP:CA
`
`"ME:
`Annnsss:
`
`CITY
`STATE, ZIP:
`
`LIENOH:
`NAME:
`
`_ Annms:
`Cm:
`
`,
`
`E:
`gamma,
`
`3892 m: 16m; 51'
`
`‘
`
`MIAMI GUNS
`
`‘31:
`
`33054
`
`REEL AUTO REPAIR INC
`*
`
`7252 NW MIAMI or
`MIAMI
`FL
`33150
`(305)757‘—1797
`
`YOU AND EACH OF YOU IS HEREBY NOTIFIED THAT TIIIE ABOVE NAMED LIENOH CLAIMS A LIE" ON THE venue DESCRIBED
`BELOW FOR SERVICE!» AND LAEOR PEflFOflMED AND/OR SIDRAEE CHARGES: IFANY.
`THE CASH SUM TO BE PAID TO THE LlENOB 'fO REDEEM THE VEHICLE FROM THE HEN CLAIMED BY THE LIENUR IS THE
`AMOUNT SET FORTH BELOW.
`.
`
`THE LIEN CLAIMED BY THE UENDQ l5 SUBJECT TO ENFORCEMENT PURSUANT TO SECTION 7 13.585 FLORIDA STATUTES.
`PROFESSIONAL LIEH AND TITLE SEIIVIcE gum. A DULY ucEIIsEn AucnoNEEn IN AND FOR THE SM‘E‘E as FLonIuA. As
`Asa" FOR THE Hana. WILL SELL AT Pusuc SALE THE FOLLOWING VEHIcLE To THE HIGHEST BIDDER punsumT To SECTION
`713.585 OFTHE FLORIDA STATU‘I’E“. FORTHE PURPOSE OPENFGRGINGTHE UEH OF THE UENus.
`_
`‘
`VEHICLE:
`Yeas:
`20“ MAKE: NISSAN
`Money; ALTIHA
`
`Bow:
`
`41).
`
`sown:
`_
`TAG:
`1N4AL11D06N390859
`vm:
`FL 33150
`MIAMI
`“WEN“ 7252 NW MIAMI cm
`THE TOTAL CASH AMOUNT SUFFICIENT TO REDEEM
`THE VEHICLE FROM THE LIEN IS AS FOLLOWS:
`
`imam
`
`1720 '00
`s
`AMOUNTOFLIEN:
`. 575‘09.
`_
`A
`”s.” w.
`TosErHEIawn-Hsmdcosrs:
`.
`-
`«.119
`1155‘»- v...” I. gun-mum"- n'vuanhI I
`:Ifiihi‘d . "It”:
`ifimfiyrveméfiyfgfiggofiggqfi 274:3“??th «2'. 3% .33 IaimM ‘1‘
`
`
`mvx 23 bza'y"—*§'~ :1 was? 1|. .‘.:93:~-:f.‘f-":Z§§:“1Q3530Q‘3’v.
`It 7;:
`~TOTAL:
`' E" "‘
`,
`s
`’
`3 3420-.0'0'
`You HAVETIIERIGHfimrl-ETWENTY THREE(23) DAYSOFTKSKOTIGE.1'0SATISF‘}lNFILLALL‘IHEABWEHEIfiIbEDCLIDISEYCOHIACIIIIG
`PROFESSIONALUHMHD'ITI'IESERVICECORP.
`'. I,=.I
`1 -.
`.n 3H I
`.
`;.
`. I.: mu:
`I : HI.
`I
`1. EITHEEVENTYOUW SATISFYTHE
`ABOVEUENVI‘II'IIINTHEGIVEIIWEPERIDDJRDFEgsImt WINDMESERVICEEW.ASABHI\TRFQRAE_HEHOR
`.
`_
`-
`avrufi‘wu‘
`“I
`‘
`\
`- 5 “ti-‘31“\WIILLtfiELLAT:EUBLIC.$ALE\
`“In-av! onunm Amazon THE
`2 3
`0A?! or
`DEC
`,mflm‘ 10 : ODc'cncx AM. (cuzcxummwumou'l-
`STATEMENT OF OWNER'S RIGHTS
`Nance THAT‘IHEOWNEI OFTHE VEHICLE OR ANY PERSON Millie Hm II on LEMON HAS A RIGHT TO A‘I‘EABIHG ATAQIY THE PRIOR
`TO THE SHIEDLILED DATE OF SALE BY FJLNE A DEWFOR HEARING WITH THEm 0311-! CREDIT CDUHTINTHE COUN‘IV ll WHICH THE VEHICLE
`IS HELD AND Mill-Ne DOPE: OF THE OW FORHEARIIO 1'0 ALLOTHER owns AND mum AB REFLECI'E NTHENOTIE-
`NOTICE THAT THE OWNER as THE vauus HAS A mar To EscoIIEa Possession OF THE VEHICLE WITHOUT 2451mm": .JUnIcIAI. Hummus Ev
`Posms A BOND Iu Accommcs wrm THE summonsorSteam STATUTE 559.9 17.