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Fillable Printable Form MV-905 - Self-Storage Owner Affirmation and Bill of Sale - New York

Fillable Printable Form MV-905 - Self-Storage Owner Affirmation and Bill of Sale - New York

Form MV-905 - Self-Storage Owner Affirmation and Bill of Sale - New York

Form MV-905 - Self-Storage Owner Affirmation and Bill of Sale - New York

New York State Department of Motor Vehicles
SELF-STORAGE OWNER/OPERATOR AFFIRMATION AND BILL OF SALE
This form is also available to download from the DMV web site www.dmv.ny.gov
SELF-STORAGE COMPANY (Business Name and Address)
DESCRIPTION OF VEHICLE OR BOAT
LIENHOLDERS (attach additional page, if necessary)
BUYER
PUBLICATION AND SERVICE OF NOTICE INFORMATION
ODOMETER DISCLOSURE STATEMENT (does not apply to boats)
DAMAGE DISCLOSURE STATEMENT – CHECK ONE BOX
Name
1. Name
2. Name
Last Name, First, M.I.
City
State Zip Code
City
State Zip Code
Year
MakeModelPlate NumberStateVehicle or Hull Identification Number (attach photo or tracing)
City StateZip Code
City StateZip Code
PRIOR OWNER
Number and Street Address
Number and Street Address (including Apt. No.)
Number and Street Address (including Apt. No.)
Number and Street Address (including Apt. No.)
Print Last Name, First, M.I.
Address Where Auction Was Held
Price
Paid
Number and Street Address (including Apt. No.)
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.
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): o5 digits o6 digits o7 digits, not including tenths.
1.
oI 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.
2.
oI certify that, to the best of my knowledge, this odometer reading “EXCEEDS MECHANICAL LIMITS”. (Odometer started over at zero.)
3.
oI certify that, to the best of my knowledge, this odometer reading is “NOT THE ACTUAL MILEAGE. WARNING: ODOMETER DISCREPANCY”.
I certify that, to the best of my knowledge, this vehicle ohas been or ohas 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.)
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:
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 buyers application for title and
supporting documentation, and have issued a Certificate of Title for the vehicle.
MV-905 (5/11)
IMPORTANT: Making a false statement, or failure to accurately disclose the salvage status of a vehicle, may subject you to substantial civil
fines, in addition to any penalties authorized by the Penal Law.
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