New York State Department of Motor Vehicles MV-905 (5/11) 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) PRIOR OWNER Name Last Name, First, M.I. Number and Street Address Number and Street Address (including Apt. No.) State City Zip Code City State Zip Code DESCRIPTION OF VEHICLE OR BOAT Year Make Model Plate Number State Vehicle or Hull Identification Number (attach photo or tracing) LIENHOLDERS (attach additional page, if necessary) 1. Name 2. Name Number and Street Address (including Apt. No.) Number and Street Address (including Apt. No.) State City 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 was in my (our) favor. Notice of Lien was sent to owner(s) and lienholder(s). Proof of mailing is attached. PUBLICATION AND SERVICE OF NOTICE INFORMATION Date of service of notice to owner: 1st Publication Date: / / / / Date of service of notice to lienholder(s): 2nd Publication Date: / / Sale Date: / / / / Name and address of newspaper: BUYER Address Where Auction Was Held Print Last Name, First, M.I. Number and Street Address (including Apt. 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) The odometer on the vehicle described above has (check the appropriate box): o 5 digits o 6 digits (no tenths) o 7 digits, not including tenths. 1. o I 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. o I certify that, to the best of my knowledge, this odometer reading “EXCEEDS MECHANICAL LIMITS”. (Odometer started over at zero.) 3. o I certify that, to the best of my knowledge, this odometer reading is “NOT THE ACTUAL MILEAGE. WARNING: ODOMETER DISCREPANCY”. 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 vehicle o has been or o has 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.) 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 buyer’s application for title and supporting documentation, and have issued a Certificate of Title for the vehicle. American LegalNet, Inc. www.FormsWorkFlow.com