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APPLICATION FOR TEXAS TITLE <br />TYPE OP PRINT NIPATi V INI MLC <br />171AQO <br />TAX OFFICE USE ONLY <br />Standard Presumptive Value <br />Tax Collector: ALBERT URESTI County: BEXAR <br />1:1 sPV $ <br />Dale: Transaction Number. - <br />❑- Appraisal Value $ <br />1. Vehicle Identification Number <br />2. Year <br />3. Make <br />4. Body Style <br />5. Model <br />6. <br />5KKHAVCY9GLGX5399 <br />2016 <br />WESTERNSTAR <br />4700SF <br />T. Empty Weight (Ibs.) <br />8, Carrying Capacity (lbs.) <br />9. Plate No, <br />I 10. Vehicle Unit No. <br />11. Major Vehicle Color <br />12. Minor Vehicle Color (two colored) <br />13. Applicant Type ❑ Individual ❑ Business ❑ Government ❑ Trust ❑ Non -Profit Business, Government, Trusts and Non.Profits, use the Business Name line below. <br />14, Applicant's/Owners Legal Name 1/Business Name CITY OF SAN MARCOS Owner's County Name <br />First Middle Last Suffix <br />Mailing Address 630 E HOPKINS STREET --City SAN MARCOS State TX Zip 78666 <br />14a. Applicant/Owner 1 Photo ID Number <br />ID Type ❑ U.S. Driver's License U.S. State Identification ❑ Texas ❑ State Territory) <br />Other (Name of or <br />❑ U.S. Passport ❑ Foreign Passport (Name of Foreign Country) ❑ U.S. Military ID EINATO ID <br />❑ Other Military Status of Forces Photo ID ❑ U.S, Department of Homeland Security ID ❑ U.S. Citizenship 8 Immigration Services ID ❑ U.S. Department of State ID <br />14b. Applicant's/Owner's Legal Name 2' ' <br />First Middle Last Suffix <br />Mailing Address City State Zip <br />14c. Registrant's Name (Renewal Notice Recipient)/Business Name <br />First Middle Last Suffix <br />Mailing Address City State Zi <br />14d. Vehicle Physical Location AddressGi State Z] - <br />15. Previous Owner's Legal Name/Business Name GRANDE TRUCK CENTER 15a. GDN -Dealer Use Only <br />--- --- ---- ---- - P8363 <br />First Middle Last Suffix <br />Mailing Address 4562 1-10 EAST city SAN ANTONIO State TX zip 78219 <br />THIS VEHICLE IS SUBJECT TO THE FOLLOWING FIRST LIEN <br />16. 1st Lien Date <br />1st Lienholder Name _S. r=s t"Ie>J"p r,5 <br />16a. Electronic Title Request? YES (16c cannot be checked) <br />Mailing Address ` �t KA V Q C,j ( <br />16b. Certified Lienholder ID No. <br />Cit y g 13to mo mvv State Zi Z j g <br />16c. Additional Lien(s)? YES (Attach Form VTR -267) <br />17. FOR CORRECTED TITLE, ❑ Change In Vehicle Description VIN ❑ No Change In ❑ Add ❑ Remove ❑ Odometer ❑ Odometer ❑year ❑Make <br />CHECK REASONS Ownership <br />Lien Lien Brand Reading <br />❑ Body Style ❑ Other <br />18. ODOMETER DISCLOSURE -FEDERAL AND STATE LAW REQUIRES THAT YOU STATE THE MILEAGE UPON TRANSFER OF OWNERSHIP. FAILURE TO <br />COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT. <br />I, GRANDE TRUCK CENTER state that the odometer now reads (no tenths). <br />(Name of Seller/Agent) <br />THE MILEAGE SHOWN IS Ej A - Actual. Mileage D N - Not Actual Mileage (WARNING -ODOMETER DISCREPANCY) p X - Mileage Exceeds Mechanical Limits Exempt <br />19. CHECK ONLY IF APPLICABLE MOTOR VEHICLE TAX STATEMENT <br />❑ i hold Motor Vehicle Retailer's (Rental) Permit No, <br />and will satisfy the minimum tax liability (V.A.T.S., Tax Code §152.046(c)). <br />I am a Dealer or Lessor and quality to take the Fair Market Value Deduction (V.A.T.S., Tax Code §152.002(c]). GDN or Lessor Number <br />20. DESCRIPTION OF VEHICLE <br />Year <br />Make <br />Vehicle Identification Number __F20a. ADDITIONAL TRADE-INS? ( 'N) <br />TRADED IN (if any) <br />21. SALES AND USE TAX COMPUTATION <br />❑ (a) Sales Price ($ N/A rebate has been deducted) $126451.00 ❑ $90 New Resident Tax - (Previous State) <br />(b) Less Trade -In Amount, Describe in Item 20 Above $( N/A ) ❑ $5 Even Trade Tax <br />(c) For Dealers/Lessors/Rental ONLY - Fair Market Value ❑ $10 GI8 Tax - Use Comptroller Form 14-317 <br />Deduction, describe in item 20 above, $( N/A ) ❑ $65 Rebuilt Salvage Fee <br />(d) Taxable Amount (Item a. minus Item b./Item c.) $ 126451.00 ❑ 2.5% Emissions Fee (Diesel Vehicles 1996 and Older > 14,000 lbs.) N/A <br />(e) % Taxon Taxable Amount (Multiply Item d. by .0625) $ N/A ❑ 1% Emissions Fee (Diesel Vehicles 1997 and Newer > 14,000 lbs.) <br />N/A <br />(f) Laatete Tax Payment Penalty ❑ 5% or ❑ 10% $ N/A <br />(g) Tax Paid to (STATE) $ N/A El Exemption claimed under the Motor Vehicle Sales and Use Tax Law because <br />(h) AMOUNT OF TAX AND PENALTY DUE <br />(Item e, plus Item f, minus Item g.) $ N/A ❑ $28 or $33 AICATION FEE FOR TEXAS TITLE <br />Contact oPPLur Count Tax Assessor -Collector for the correct fee. <br />I HEREBY CERTIFY THAT ALL ST EMENTS 1N S DOCUMENT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. <br />22. GRANDE TRUCK CENTER t'� <br />Signature of SELLER, DONOR, OR TRADER 1 0 PRINTED NAME (Sam gnature) 1 Date <br />23. <br />Signature of SELLER, DONOR, OR TRADER 2 PRINTED NAME (Same as signature ) 2 Date <br />24. <br />Signature of PURCHASER, DONEE, OR TRADER 1 PRINTED NAME (Same as signature) 1 Date <br />25. <br />Signature of PURCHASER, DONEE, OR TRADER 2 PRINTED NAME (Same as signature ) 2 Date <br />WARNING: Transportation Code, §501.155, provides that falsifying information on title transfer documents is a third-degree felony offense punishable by not more than ten (10) <br />ears in prison or not more than one 1 year in a community correctional facility. In addition to imprisonment, a fine of up to $10,000 may also be imposed. <br />37 /U9"1 "GTC-M <br />Form 130-U (Rev. 8/2013) Online Form at www.TxDMV.gov Page 1 of 2 <br />