Mv 905 Form – Fill Out and Use This PDF

SELF-STORAGE COMPANY (Business Name andAddress)	PRIOR OWNER
Name	Last Name, First, M.I.

DESCRIPTION OF VEHICLE OR BOAT

Year	Make	Model	Plate Number	State	Vehicle or Hull Identification Number (attachphotoortracing)

LIENHOLDERS (attach additional page, if necessary)

1. Name

2. Name

Number and StreetAddress (includingApt. No.)

Number and StreetAddress (includingApt. No.)

City

State

Zip Code

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 wasin my (our) favor. Notice of Lien wassent to owner(s) and lienholder(s). Proof of mailing isattached.

PUBLICATIONAND SERVICE OF NOTICE INFORMATION

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:

BUYER

Print Last Name, First, M.I.

Address WhereAuction Was Held

Number and StreetAddress (includingApt. No.)

City

State

Zip Code

Price

Paid

ODOMETER DISCLOSURE STATEMENT (does not apply to boats)

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(checktheappropriatebox): o5digits	o6digits	o7digits,notincludingtenths.

1.o I certify that, to the best of my knowledge, thisodometer reading reflectstheACTUALMILEAGE as seen on the odometer of the vehicle described above.

2.o Icertifythat,tothebestofmyknowledge,thisodometerreading“EXCEEDSMECHANICALLIMITS”.(Odometerstartedoveratzero.)

3.o Icertifythat,tothebestofmyknowledge,thisodometerreadingis“NOTTHEACTUALMILEAGE.WARNING:ODOMETERDISCREPANCY”.

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.

DAMAGE DISCLOSURE STATEMENT – CHECK ONE BOX

I certify that, to the best of my knowledge, this vehicleohas 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 vehiclemusthaveananti-theftexaminationbeforebeingregistered,andthatthetitleissuedwillhavethestatement“RebuiltSalvage:NY”onit.)

The information in the “Statements” above istrue 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 buyer’s application for title and supporting documentation, and have issued a Certificate ofTitle for the vehicle.