Bill of Sale

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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 (seller) does hereby sell, transfer and deliver unto ______________________________________________________________________ (buyer), his right, title and interest in and to the following described vehicle: License Plate No. __________________ Vehicle Identification No. ___________________________________________ Make and Model Year ________________________________ Body Type _________________________ The said seller hereby warrants that he is the lawful owner of said vehicle; that it is free from all liens and encumbrances except *lien in favor of _________________________________________________ NAME *If no lienholder shown, transfer will be processed _______________________________________________________________________________ without recording lien. ADDRESS CITY STATE ZIP CODE Federal and state laws require that you state the mileage in connection with the transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment. I certify that the odometer now reads ___________________________ (no tenths) and to the best of my knowledge that it reflects the actual mileage unless one of the following statements is checked: o (1) The odometer reading reflects that amount of mileage in excess of its mechanical limits. o (2) The odometer reading is NOT the actual mileage. WARNING: ODOMETER DISCREPANCY. Signed this ______ day of _________________ , 20 ____ ______________________________________________ Signature of Seller ______________________________________________ Printed Name of Seller ______________________________________________ Signature of Seller ______________________________________________ Printed Name of Seller ______________________________________________ Address ______________________________________________ City State Zip Code Subscribed and sworn before me this _________ day NOTARY CERTIFICATION: of _______________________________ ,20 _____ . (Hawaii Administrative Rules §5-11-8) Document Date: _________________ No. Pages: ______ __________________________________________ Document Description: ____________________________ Notary Public State of Hawaii, _________________ Judicial Circuit Notary Printed Name Circuit My commission expires: _________________ Notary Signature Date (Stamp or Seal) (Stamp or Seal) CS-L(MVR)40 (Rev. 9/10).

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