Please describe the vehicle being sold Year Make Mode

Motor Vehicle Administration 6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062

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Please describe the vehicle being sold

Year

Make

VVRR--118811((0131--1083))

If this form is used to establish the purchase price of your vehicle, a notary is required.

Model

Body Style

Vehicle Identification Number

I/We do hereby sell to:

Name of buyer(s) _______________________________________________________________

For the total sum of $ _________________, which has been received. This sum represents the mutually agreed upon purchase price of

the vehicle, between both the buyer(s) and the seller(s). The reason the vehicle may be purchased for a price less than the fair market value is as follows. ________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

To the best of my knowledge, the odometer reading is the actual mileage of the vehicle unless one of the following statements is

checked:

? 1. The mileage is in excess of its mechanical limits.

odometer reading ______________________ (no tenths)

? 2. The odometer reading is not the actual mileage.

Warning- Odometer Discrepancy

Please notarize your sale. A second space is provided for notarizing an additional party to the transaction who may not be present at the initial notarization. It is not necessary to require two notaries if one will suffice for all parties.

I/we certify under penalty of perjury, that the statements made are true and correct to the best of my/our knowledge, information and belief. I understand that giving a false statement(s) is a misdemeanor and subject to fines not exceeding $500, imprisonment for not more than 2 months, or both.

This _____________ day of ______________ (year) ____________ Seller(s) signature(s) _________________________________________________________ _________________________________________________________ Seller(s) printed name(s) _________________________________________________________ _________________________________________________________

Subscribed and sworn to before me:

This _____________ day of ______________ (year) ____________ Buyer(s) signature(s) _________________________________________________________ _________________________________________________________ Buyer(s) printed name(s) _________________________________________________________ _________________________________________________________

Subscribed and sworn to before me:

This _____________ day of ______________ (year) _____________ Notary Public signature _________________________________________________________ Notary Public printed name _________________________________________________________ My Commission Expires ____________________________________

This _____________ day of ______________ (year) ____________ Notary Public signature _________________________________________________________ Notary Public printed name _________________________________________________________ My Commission Expires ___________________________________

Place Seal Here

Place Seal Here

For more information, please call: 1-800-638-86360417 (RtoitucchhietHonigehcwaallys, oNn.Ely.),,G1-le8n00B-u9r5n0ie-,1MMaVrAyla(1n6d8221)(0to62speak with a customer service representative), FForor mmoOrueti-noffo-rSmtaatteio: n1-v3is0i1t -o7u2r9w-4e4b5si0t,eTaTtYwfworwt.hmevhae.marainrgyliamnpda.giroedv,: c1a-8ll0401-04-9726-84-577050.0VoisritToTuYr fworebthseiteheaatr:inwgwimw.pmaairerydl:a1n-d8m00v-a4.9c2o-m4575.

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