BICYCLE/MOPED BILL OF SALE

KNOW ALL MEN BY THESE PRESENTS:

That in consideration of Dollars and

other valuable consideration the receipt whereof is hereby acknowledged,

the undersigned does hereby sell, transfer and deliver unto

(name buyer who is an adult 18 years of age and older) his right, title and

interest in and to the following described bicycle/moped:

MAKEYEAR MODEL

Seller’s Signature

Seller’s Address

Street No. / P.O. Box

CityStateZip Code

BUYER’S CERTIFICATION

I (we) hereby certify that I am (we are) the purchaser(s) of the bicycle/moped

described above and that I (we) have examined the bicycle/moped and

found the serial number and description to be correct as written in the bill of

sale; and that I am (we are) of legal age (18 years of age and older).

Buyer’s Signature

Buyer’s Address

Street No. / P.O. Box

CityStateZip Code

Dated, 2