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HomeMy WebLinkAboutPR 20591: DONATION OF A 2019 FORD ESCAPE FROM TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES Away City of D� �l �lrt I-thur Texas DATE: November 27, 2018 To: Harvey Robinson, Interim City Manager From: Judith A. Smith, RN, BSN RE: Approval to accept the donation of a 2019 Ford Escape from the Texas Department of Health and Human Services to be utilized for the WIC Program. This vehicle is donated and no cost to the City. Nature of the Request: Recently, the Texas Department of Health and Human Services WIC Program submitted a survey to WIC Programs around the state to utilize FY 2018 surplus funds. As a result of the survey some of the WIC clinics were recipients of a 2019 Ford Escape. The Port Arthur Health Department WIC clinic is one of the WIC programs selected to receive a 2019 Ford Escape. This vehicle will be used by the WIC staff to travel for official WIC business. All vehicle maintenance, inspections, and repair services will be funded by WIC Vehicle Maintenance Acct. 101-1331-542.43.00. Staff Analysis, Considerations: WIC staff will be able to utilize the vehicle to travel for official WIC business. Recommendations: It is recommended that the City Council approve P.R. No.20591, which is the acceptance of the donated 2019 Ford Escape from Texas Department of Health and Human Services for the WIC Program to travel for official WIC business. Budget Considerations: Texas Department of Health and Human Services has already purchased the vehicle from Smith South Plains for$21,914.18 for the WIC program; therefore this will be no cost to the City. All funds necessary for vehicle maintenance will be paid for by WIC grant funds. "REMEMBER WE ARE HERE TO SERVE THE CITIZENS OF PORT ARTHURP.O.BOX I089•PORT ARTHUR,RTHUR, TX 77641-1089• 409/983-8101•FAX 409/982-6743 P.R.NO. 20591 l 1/27/2018 js RESOLUTION NO. A RESOLUTION TO ACCEPT THE DONATION OF A 2019 FORD ESCAPE FROM TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR THE CITY OF PORT ARTHUR WIC PROGRAM TO TRAVEL FOR OFFICIAL WIC BUSINESS. ALL VEHICLE MAINTENANCE, INSPECTIONS, AND REPAIR SERVICES WILL FUNDED BY WIC GRANT FUNDS VEHICLE MAINTENANCE ACCOUNT, 101-1331-542.43 WHEREAS, recently, The Texas Department of Health and Human Services WIC Program submitted a survey to WIC Programs around the state to utilize FY 2018 surplus funds. As a result of the survey some of the local WIC clinics were recipients of a 2019 Ford Escape; and, WHEREAS, The City of Port Arthur WIC Program was one of the recipients of the 2019 Ford Escape which will be utilized to travel for official WIC business. NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT ARTHUR: Section 1. That,the facts and opinions in the preamble are true and correct. Section 2. That, the City Council of the City of Port Arthur hereby approves the acceptance of the donated 2019 Ford Escape for the WIC Program. Section 3. That, the City Council deems it is in the best interest of the City to approve and ratify the City Manager's execution of all necessary documents for the WIC Program to receive this vehicle as delineated in Exhibit"A". Section 4. That, a copy of the caption of this Resolution be spread upon the Minutes of the City Council. P.R.NO. 20591 Page 2 READ,ADOPTED, AND APPROVED, this day of 2018 at a Regular Meeting of the City Council of the City of Port Arthur, Texas by the following Vote: AYES: Mayor: Councilmembers: NOES: Mayor ATTEST: Sherri Bellard, City Secretary APPROVED AS TO FORM: ASi41..e Va'cia Tize!'ity •. om, 11 APPROVED FOR ADMINISTRATION: RAI choW Harvey Robinson, Interim City Manager Ju@'ith Smith. R.N. BSN. Director of Health g EXHIBIT "A" _� 4 County of Title Issuance Texas Department of Motor Vehicles Instructions for Motor Vehicle Dealers Transportation Code, §501.0234, requires licensed motor vehicle dealers to apply for title and initial registration for a motor vehicle in the county as directed by the purchaser(s). A dealer may not pre-populate a county selection on this form for the purchaser(s). Do not submit this form with the title transaction. The original form should be retained with the dealer's vehicle records. This form is not required if the purchaser(s) will be immediately removing the vehicle from Texas. Instructions for Purchasers Vehicle purchasers select the Texas county where a licensed motor vehicle dealer files a title transaction to transfer title and/or initially register the purchased vehicle. The county selected will receive a portion of the sales tax, title fees, initial registration fees,and other applicable state and local fees. Subsequent registration renewal notices will automatically be mailed to the purchaser from the purchaser's county of residence if it is different from the selection on this form. Purchaser(s) choose where their transaction is filed from one of the below: • County of residence of the purchaser(s) • County where the motor vehicle is purchased • County where the motor vehicle is encumbered (by the lienholder) If the county selection on this form has been pre-populated by the dealer, please visit www.TxDMV.gov, and select the "Motorist"tab to file a complaint against the dealer. Note: If you sold your vehicle, or traded your vehicle into a dealership,you can also protect yourself by submitting a Vehicle Transfer Notification online at www.TxDMV.gov. Vehicle Information Vehicle Identification Number Year Make Body Style Model ao it OCr1 Ef(Ayr County Selection-This field should not be pre-populated by the motor vehicle dealer File my transaction in the following Texas county:,,,, ie Son Acknowledgement I acknowledge th t I was provided with this form and have voluntarily selected the county listed above in which to have the title application and ' •' al registra •' n, if applicable,filed by the dealer. , . / H cif ve L, 'Rt i rlsc i i 1 /Z7 II 3 ""Tignature of Purchaser Printed Name(Same as Signature) Date Signature of Additional Purchaser(if any) Printed Name(Same as Signature) Date VTR-136 Rev 08/16 Form available online at www.TxDMV.gov Page 1 of 1 el ler SMit \Gn.t eller' ddress1 (VAl o ,J T Phone. N- 3 (1 3u er il. Buyer's Address klqg 11(4.071v Avt POr't-61--f-L, y 3uyer's Phone: Cell Home Business Email give my permission to Seller to contact e on any of the above listed numbers, by text message, and by email. /Il I Make i Model (ScApt MY 1/ Stock No. Ile above-described vehicle is subject to the following recall: /17/# Attached are the following, if available: I. Print out from the National Highway Traffic Safety Administration's (NHTSA) website, www:safercar.gov for this vehicle. 2. Information from the manufacturer or distributor regarding the recall. 3. Other The part recall repair information from the manufacturer or distributor provides: ❑ Expected from manufacturer or distributor by ❑ Not available at this time. ❑ Unknown when it will be available. El When parts are available, buyer will be contacted by the manufacturer to return the vehicle for a free recall repair. If you drive the vehicle without the recall repaired, the manufacturer or distributor states • I understand that not performing the recall repair may impact the vehicle's future value. Unless the Seller makes a written warranty or enters into a service contract within 90 days from the date of the executed retail installment contract or purchase agreement,the Seller makes no warranties,express or implied,on the motor vehicle and there is no implied warranty of merchantability or of fitness for a particular purpose. I. as Buyer of the above described vehicle, assume the risk of the purchase and I agree to purchase the vehicle with all faults. This provision does not affect any warranties covering the motor vehicle that the motor vehicle manufacturer may provide. Buyer acknowledges that: Any question I have regarding the recall, repair, and the vehicle has been answered to my satisfaction by the Seller. The information on this form and any attachments were disclosed and given to me prior to my agreeing upon a sales price for the purchase of this vehicle. The information on this rm and any attachments were disclosed and given to me prior to my signing any purchase agree ent or etail installment contract. I aglee to d'cl le ve information to the next buyer. 11 �� II Date buyer's i ature Date Seller's Signature NOTARY COMPLETION OPTIONAL State of Texas County of This instrument was signed before me on (date) by • Notary Signature Notary Stamp 00,-...1,...r.,,.,,TAns c..,-,;,-,, 1 111R r C,,ir,,r.rur 4n.hn TX 7X1(11 NATIONAL VEHICLE SERVICE CONTRACT ; soxir I c o APPLICATION, TERMS & CONDITIONS (All vehicles up to and including Transit and F-550) PROTECT REGISTRATION INFORMATION FPLP 8240-NAT APPS/PROVS-W/KEY(AUG 18) I Vehicle Identification Number("VIN")(17 Digits) Signature Date Warranty Start Date I 11/26/2018 11/26/2018 I CPO Internet Sale Current Mileage 1 Current Hours* IPP Term ❑ Incomplete ❑Yes 0 N 12 0 1 I (Cab/Chassis) Surcharges: Cj Limo/LiveryWrap ❑12 Months/12,000 Miles ❑36 Months/36.000 Miles(Ford Competitive Make)or 48 Months/50,000 Miles(Lincoln Vehicles) ❑Snowplow ❑X Commercial Use ❑Specialty-Emergency(Fire,Ambulance) I L Component Wrap ❑Specialty-Emergency(Fire,Ambulance,Police pursuit units-except Ford Police Interceptor),Limo.Livery.Shuttle,Tow Truck j (Non-CPO) New Plan Coverage: Core-PowertrainCARE.BaseCARE,ExtraCARE,PremiumCARE(Standard Deductible is$100) LeaseCARE-New PremiumCARE with Wear Items-(Standard Deductible is SO) Rental Care-(RentaICARE-Standard Deductible is$0) Super Duty Coverages-(Diesel EngineCARE,Diesel EngineCARE Plus-Standard Deductible is$100) Used Plan Coverage:Core(PowertrainCARE,BaseCARE,ExtraCARE,PremiumCARE-Standard Deductible is$100) PLAN COVERAGE ❑X New Plan ❑Used Plan Deductible Plan Term Plan Expiration-(Earliest of all 3) Purchase Sales Tax Total Purchase Price Plan Name APrice with Sales Tax Month Mileage Hours' Date Mileage Hours' PremiumCARE $100 60 1100000 11/26/2023 100000 S 1390 $0.00 $1390.00 i Options Z First Day Rental Delete ❑Enhanced Rental g Key Services Delete ❑Interior/Exterior Lighting Delete ❑PDL(Lincoln Only) Deductible I Plan Term Plan Expiration-(Earliest of all 3) Purchase Sales Tax Total Purchase Price Plan Name Bprice with Sales Tax Month Mileage Hours* Date Mileage Hours' $ $ $ Options ❑First Day Rental Delete 0 Enhanced Rental D Key Services Delete ❑Interior/Exterior Lighting Delete ❑PDL(Lincoln Only) 'Super Duty and Incomplete Vehicle Plan Coverages require current hours and expiration Total $1390 I$0 00 $1390 00 hours for all vehicles with an hour meter. DISCLOSURE INFORMATION: THE PURCHASE OF THIS AGREEMENT IS NOT REQUIRED IN ORDER TO PURCHASE,OR OBTAIN FINANCING FOR A MOTOR VEHICLE.YOU MAY PURCHASE THE SERVICE CONTRACT BY CASH OR UNSECURED CREDIT CARD.IF YOU ELECT TO PURCHASE THIS AGREEMENT,IT GIVES YOU SPECIFIC LEGAL RIGHTS, WHICH MAY VARY FROM STATE TO STATE. I acknowledge receipt of a complete copy of this Application and Terms and Conditions(the"Agreement")at signing and agree to all the terms and conditions.I agree to maintain the covered vehicle in accordance with the manufacturer's stated periodic maintenance recommendations as a condition of receiving coverage under this Agreement, except as otherwise provided by law. Mississippi Residents Only:By signing below,I agree to the binding Washington Residents Only: By initialing this box.I acknovl- I arbitration language in the Mississipi Section. edge I have reviewed with Dealer the section of this Service Contract titled, What This Agreement Covers and What is Not Covered Your Responsibility for Care of the Vehide.Implied Warranty of Merchantitibility and Your and Our I Signature(not valid without Sign re) Rights to Cancel Agreement SERVICE CONTRACT H r DER/PURCHASER Signatugr(Not Valid, •ut .ignature) Signature Date I ) 11/26/2018 ktne Address I city of port arthur 449 austin ave City State Zip Code E-Mail Address Service Contract Lienholder Name port arthur TX 77640 DEALERSHIP INFORMATION I Dealership Signature Dealer Name I Smith South Plains Ford Address 1 Address 2 2483 E.Highway 114 City State Levelland TX Zip Code Telephone No I 79336 Employee Stars Id P&A Cod 11 i 0 31 s 5 � 3 1 FOR OFFICE USE ONLY FPLP 8240-NAT APPS/PROVS-W/KEY(AUG 18) Application tor i exas I itie anaior Kegistration Applying for(please check one): TAX OFFICE USE ONLY 0 Title&Registration n Title Only Registration Purposes Only Nontitle Registration county: For a corrected title or registration,check reason: Doc It: .72 Vehicle Description C Add/Remove Lien 0 Other: 0 SPV 0 Appraisal Value$ 1.Vehicle Identification Number 2.Year 3.Make 4.Body Style 5.Model 6.Major Color 7.Minor Color 2 019 KM CR 3JV a+.AE'E 14-0.'1£ 8.Texas License Plate No. 9.Odometer Reading(no tenths) 10.This is the Actual Mileage unless the mileage is: 11.Empty Weight 12.Carrying Capacity(if anyj 1 3 2 0 Not Actual C Exceeds Mechanical Limits 0 Exempt 13.Applicant Type 14.Applicant Photo ID Number or FEIN/EIN C Individual E3 Business C Government ❑ Trust C Non-Profit 15.ID Type El U.S.Driver License/ID Card(issued by: ) C NATO ID Ci U.S.Dept.of State ID C Passport(issued by: ) C U.S.Military ID G U.S.Dept.of Homeland Security ID C U.S.Citizenship&Immigration Services/DOJ ID ❑ Other Military Status of Forces Photo ID 16.Applicant First Name(or Entity Name) Middle Name Last Name Suffix(if any) CITY OF PORT ARTHUR 17.Additional Applicant First Name(if applicable) Middle Name Last Name Suffix(if any) 18.Applicant Mailing Address City State Zip 19.Owner County of Residence 449 AUSTIN AVE PRT ARTHUR TX 77640 J)�1.ERSDN 20.Previous Owner Name(or Entity Name) City State 21.Dealer GDN(if applicable) 22.Unit No.(if applicable) SMITH 3Dt IIH PLAINS EMERY T,EUE.LIAND TX P 3 8 6 6 5 23.Renewal Recipient First Name(or Entity Name)(if different) Middle Name Last Name Suffix(if any) 24.Renewal Notice Mailing Address(if different) City State Zip 25.Applicant Phone Number(optional)26.Email(optional) 27.Registration Renewal eReminder ( 409 ) 983-8845 CHRISTINA. PATTESON@PORTARTHURTX . GOV Yes(Provide Email in#26) 28.Vehicle Location Address(if different) City State Zip 29.Multiple(Additional)Liens t0.Electronic Title Request 31.Certified/eTitle Uenholder ID Number(if any) 32.First Lien Date(if any) 0 Yes(Attach Form VTR-267) 0 YeS(Cannot check#29) 33.First Lienholder Name(if any) Mailing Address City State Zip 34.Check only if applicable: MOTOR VEHICLE TAX STATEMENT ❑ I hold Motor Vehicle Retailer's(Rental)Permit No. and will satisfy the minimum tax liability(V.A.T.S.,Tax Code 4152.046[cJ) ❑ I am a dealer or lessor and qualify to take the Fair Market Value Deduction(V.A.T.S.,Tax Code,*152.002(c)).GDN or Lessor Number 35.Trade-In(if any) Year Make Vehicle Identification Number 36.Additional Trade-In(s) 0 Yes(Complete) C Yes 32..Check only if applicable: N/A SAIM ANI-M AX COMPUTATION l f (a) Sales Price($ rebate has been deducted) $ N/A 0 $90 New Resident Tax-(Previous State) (b) Less Trade-in Amount,described in Item 35 above $( 1 0 $5 Even Trade Tax (c) For Dealers/Lessors/Rental ONLY-Fair Market Value N/A F 0 $10 Gift Tax-Use Comptroller Form 14-317 18,_ -T.fi Deduction,described in Item 35 above $( 9 d) 0 $65 Rebuilt Salvage Fee � (d) Taxable Amount(Item a minus Item b or Item c) S ; '185.94 ❑ 2.5%Emissions Fee(Diesel Vehicles 1996 and Older>14,000 lbs.) (e) 6.25%Tax on Taxable Amount(Multiply Item d by.0625) $ wA 0 1%Emissions Fee(Diesel Vehicles 1997 and Newer>14,000 lbs.) (f) Late Tax Payment Penalty 0 5%or 0 10% $ NIA 0 Exemption claimed under the Motor Vehicle Sales and Use Tax Law because: (g) Tax Paid to (STATE) $ (h) AMOUNT OF TAX AND PENALTY DUE 1 185 ❑ $28 or$33 Application Fee for Texas Title (Item e plus Item f minus Item g) $ (Contact your county tax assessor-collector for the correct fee.) CERTIFICATION-State law makes falsifying information a third degree felony I hereby certify all statements in this document are true and correct to the best of my knowledge and belief,and I am eligible for title and/or registration(as applicable). SMITH SG`'t1Th PLAINS ; •7TERPRISES 11/26/2018 Sign ture(s o •. /,Donor(s),or Tra.- s) Printed Name(s)(Same as Signature(s)) Date CITY OF PORT AF?THJR 11%26/2018 41Iignatur• j .plica : ner Printed Name(Same as Signature) Date Signature(s)of Additional Applicant(s)/Owner(s) Printed Name(s)(Same as Signature(s)) Date Form 130-U Rev 08/16 Form available online at www.TxDMV.gov Page 1 of 2 l+c, :2,20,0 WHAT DOES SMITH SOUTH PLAINS FACTS DO WITH YOUR PERSONAL INFORMATION? MIFinancial companies choose how they share your personal information.Federsrl law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect.share, and protect your personal information. Please read this notice etartfully to understand what we do. What? The types of personal information we collect and share depend on the product or servic.e.yoti • have with us.This information can include: a Social Security number and Date of Birth a Drivers License and Address ■ Phone Numbers . and Banking Account Information When you are rlo forvor our Customer,we continue to share your information as described in this notice. HOW? Ali financial companies need to share Customer's personal information to run their everyday business. to the section below,we list the reasons financial companies can share their Customer's personal information;the reasons Smith South Plains chooses to share;amd whether you can limit this sharing. Does Smith South Can you limit this sharing? Reasons we can share your personal information plain. Share.? For our everyday business purposes— • such as to process your transactions, maintain No your account•isl,respond to court orders and legal Yes investigations,or report to credit bureaus For our marketing purposes— Yes No to offer our products and services to you For joint marketing with other financial companies Yes • No For our affiliates'everyday business purposes— No information about your transactions and experiences No • For our affiliates'everyday business purposes— No No information about your creditworthiness For nonaffiliates to market to you Yes No Questions? Call 806-894-3191 or go to www.smithsouthplains.com • Who we are Smith South"Plains Who is providing this notice? • • What we do How does Smith South Plains To protect yoatr peraonat information from unu...thoriZai1 a Ka protect my personal information? and use,we use security moasurea that comply with+federal law. These measures include computer safag.terds and aacu,ad fit..v arid buildings. How does Smith South Plains We couact your personal information. for example.when you collect my personal information? a When you Apply for Credit or When Providing Service a Purchasing parts or Body Shop Services is Requesting Information Online Why can't I limit all sharing? Federal law gives you the right to limit only a sharing for affiliates'everyday business piJr130se3^-iniornmtwn about your CreditworthrneSS affiliates from using your information to market to you e sharing for nonaffiliates to market to you State sindividual mit sharing. Se belowfor mere on your give cOmpaniaa may rights under State Law.tS to Definitions common ownership or control.They can be affiliates Companies related by financial and nonfinancial companies. • a None Nonaltiliates Companies not related by common ownership or control.They can be f,nnncitit end nonfinancial companies. a For Exempt.: F • ^M yC . ARSE . Joint marketing tA formal one;her arket finaont ncial nonaffiliatedtween tia prodv is orservices tofinancial that you_ a For Exempre: FMCC, COJ . ALLY,; CHASE Other important informationrscsivsa dopy of tills Privacy Notice from d Acknowtedgment of R t: • 1 Smith South Plains. .y C/� i/�41P. : • Customer Signetu _ Printed Name 1 . a ;t' t. _.. _ Date 1 I billi"' .,v.,+..-'^-- N 7o coZ70 cK 303 a ro r: 00 CD m = w xo 333 20 CD o a; a ca m < CD = 0 r7 7 y 1: 7 m A Cn Q' N _ co co D N T A Q Co 7 TJ :A N t/1 O S 7 fL Q: d O 3 > m Q F C QTS .-5- p. co SD m m r O K m 0 S a O C a 0 3 7 CA __. m C') 1 a 0 c Az T as f 3 X m v 3 N t/) D -r ¢ n C 3 a o p C• n o (In 6m C T7 7 d t2 m m a D C -i N • cQ n A n t9 c O y a m -CD �_ n A a z .T 15 op n m N m 0 z C7 17 a 07 n a y 0 3 m m x C)„, m m fi 0 n D z m m is C 'Q 7 EA 8- a o. 41 N•m N o m N m �. �_ CD CD ° m 0 Z a'-< 3 o v g n = 0 m Q F K - a> 7 G7 C _p Ul 7 d :0 8 O n C A' m 0 = to i Et; g z c; a cD ¢ 3 -. ry j 7 m n o m ., a D A C o d z N g d co a Q —. n 3 3 v � r- . _ 7 a x P'- m •O 's J— m d K N m�O CD D c 3 "O 7 < CD A T N 'o A C N 3 07 d a g Q W 0 c E---. n N U A 0 N 0. m 0 m N = T A A .15 p O O O S O m Q Ci 7. r:0 - -, 0 CD c 3 .-4.• ' N CD m CD 7 K CD m O- AO a • C -o CC m SD At Tl = 0 X 3 a a - 0 b ... /� � ccoo N Op O C ? c N N -% V CD 7 > 4 J G -, 0 F v y - a � 5 -i 0 0 3 e 3 n o to o. n < c D a �' -' -' aA GS 0 -e ^ e (D !D C N O m e Cr 6 n Cr c- AO., 10 CD n o n m ea 0 N - m d 0. 3 0 O.-0 tri xl 7 y co O V O m N m n c O co O a KO N `7G d `� fp A o j co Cl N C tD w !n A y co o 0 a s 0 3 0 m m K - CD V a 3 AM" M Mir �• O CD a CD c CL n. N to 0 <O O N 0--C T o m 5 - 3>rn3 7r o y c H ID < n y 3 F. 5 np c C ? a C A tD 3 S S N N A CD N 7. T 3 m N N N O N CD CL D. 7 ny 0 CD `.� O O O = ? N ri A y c D • a 0 o _ m o o a NA F CL CD 7 O 7 a u> > 7 CO -. CD C) o fl A co Q a W cc, . a A C C aN � X 27o -0 < Cf) m N 9 p} n A Q m CD7 Xi 9 K gy FE 0 d -t-, _ J •z Cl. 7 0 v N m A m a o y = m ii> so 13 ccn m o m n to of 3 m a m o 3 V a 0 c m p c Al Al r ro 07 7 \.' -..••• ...• ici6 . /\ 33 � (C N 7 O co , II1 < n o cn r ' yn CN En ma mc CDD 7 9. t! 0 0 0 rin ON • 1 �� 3 � ao co 2. m 3'm m 0 C0D m o J N ss a ac Z O O ow - gym N XI Na, = N � rn N m tD Oo O ET). S A j tv lV A [D A �}► a a o f r._ Federal law(and State law,if applicable)requires that you state the mileage upon transfer of ownership Failure to complete or providing a false statement may result to fines and'or imprisonment. SMITH SOUTH PLAINS ENTEPCPRISES LT�sstate that the odometer now I, TRANSFEROR'S t.'AME-PRINT t w - reads — ''` .. -- (no tenths)miles and to the best of my knowledge that it reflects the actual mileage of the vehicle described below,unless one of the following statements is checked. 1 tit I hereby certify that to the best of my knowledge the odometer reading Ii reflects the amount of mileage in excess of its mechanical limits I l (2) I WARNINGy thaOt DOMETER DISCRs EPANCY.ual mileage. MAKE FORD — mom ESOP _ TTYFE 4DR SUV VEHiCt E IDENTIFIGATIO�:NI}l19ER YEAR 20 1 9 ----- TRANSFEROR 4 "TRANSFERORS NAME SMITH SOUTH PLAINSE ENTERPRISES LTD.PRINTNAME) PO BOX 13 4 9 ------------'-- TRANSFEROR'S ADDRESS (STREET) LEVELLAND TX 79336 CITY ISTATEI (ZIP CODE) TRANSFERORS NAME X ------------ (SIGNATURE. DATE OFSTATEMENT NOVEMBER :S .____40x--- . TRANSF'EREE'S NAME CITY OF P ORT___AR THU _4 4 ATJ 5 E__A`�E —_____ — TRANSFEREE S ADDRESS (STREET) I? rr ri r-- r i'' ITY� (STATE) ;ZIP CODE) rC TRANSFEREE'S NAME - tSIGNATUREI r'` m r r,1,- • . •• •1 (PRINTED NAME) WKA' TADA-65.4'+0 5 slum PLAN `SLATON . LEVELLANDJ FIRST FREE OIL CHANGE As you are aware, regularly scheduled maintenance is required to protect your investment in your vehicle and keep your warranty valid. The following excerpt was taken from warranty guide booklet of your vehicle. "It is your responsibility to make sure all of the scheduled maintenance is performed and the materi- als used meet Ford engineering specification. Failure to perform scheduled maintenance as specified in the Owner's Manual will invalidate warranty coverage on parts affected by the lack'of maintenance." Make sure you retain receipts for completed maintenance work not performed at Smith South Plains. Smith South Plains offers competitively priced maintenance services. To assist you in meeting the manufacturers requirement, we are scheduling your first oil change appoint- ment provided at no cost to you. Our Service Department will contact you in advance of this appointment to confirm your reservation for your complimentary oil and oil filter change. In addition, we welcome you to our service rewards program! With a simple key chain punch card, every fifth oil change is free. Appointment Date Appointment Time CITY OF FORT ARTHUR RANEY ROGERS Customer Name Sales Consultant 2. 2 Vehicle !Cent' tion Number Mileage 1.1/:6 /2018 Customer Signature Date of Sale ( 409 983-8E4 Daytime Phone Number Contact Name White Copy-File Yellow Copy-Customer I� p 3. i t � Tm -4 > , � T _—+ rJ7 j T mom .� p .x ig --L, K m p cr) . .....,m g , i o Zm i r i N =m m i .... IZbi O Ai m I co i a :f I f m _� �N 1-b I o ' ' Im I 1 'aG ! ( t o , ` tL e_ r,v � I I i > Z � m �, � � � 1.. i I �N 7 0, q i • m © Ia ' 1 I I im Z il •n D a 1 mm � � aw m 71C os o m0 Zo ri ri= I i-4 j'z 11. ini -4 a * Im a �D ! IO D O mu' II I 33 m 0 ;) m i„,s:.. 0 ia 1__4 !• , I 1Fil 1 c D2 v ° _ p M m I! e1 -iQ y I6 lin ''mss � ► ' I I m ciI I r I I m I ! .30 I C I I THE PRINTER z.WIE5 NO WARRANTY EIPPES5 OR C;C,.AL JAC KF T IUP4EG AS TO CONTENT OP FITNESS FOR PURPOSE OF *1•45'OR14 cONSV_T,OUR 0W1 LP A:COUNSEL BUYERS ORDER Salesman a}Tr;. r PIT Stock No. a T8 - C, � _ F . t �. Date >.;r„. ,�tt SOUTH PLANS - (SLATON_LEVELLAND) PURCHASER INFORMATION: SOCIAL SECURITY#: DOB: / CO-BUYER: SOCIAL SECURITY#: - DOB: / f CITY: r j T pjr+1,R STATE: , '_ ZIP: , 4 is ADDRESS: • ,� _.'_�=��ti /AT, PHONE#: (H) 4,r): t c.:' c,.: (W)-, i0' ? t.� _ : c (W) EMAILr'+'TC JA PI?'''Tf-::;ri.'•(aP(' TAP': -I;,rV '+(1. PURCHASED VEHICLE: SELLING PRICE: ':F YEAR:' MAKE: j= MODEL: Zw y�:E TRADE ALLOWANCE: BODY STYLEL--,..R �.r MILES: i REBATE: P; .b : � TRADE DIFFERENCE: VINif SALES TAX: rA r ,i COLOR: 1,' ` LICENSE PLATE# LICENSE FEE: TRADE-IN VEHICLE: .. 23 . TITLE FEE: u° _ - 5 YEAR: MAKE: MODEL: STATE INSPECTION: BODY STYLE. MILES: ^ . C2-0'„ DEALER INVENTORY TAX: DOCUMENTARY FEE: VIN# ? lr.fr . ` COLOR: LICENSE PLATE# TOTAL: C V , G:1 . 1 8 LIEN HOLDER: TRADE PAY-OFF: 14 r, *A DOCUMENTARY FEE IS NOT AN OFFICIAL FEE.A DOCUMENTARY SERVICE CONTRACT: 1 , 2`,--'0 . Ar FEE IS NOT REQUIRED BY LAW,BUT MAY BE CHARGED TO BUYERS CREDIT INSURANCE: FOR HANDLING DOCUMENTS RELATED TO THE SALE.A DOCUMEN- % ' TARY FEE MAY NOT EXCEED A REASONABLE AMOUNT AGREED TO GAP COVERAGE: BY THE PARTIES.THIS NOTICE IS REQUIRED BY LAW. TOTAL: _,� 8 DISCLAIMER OF WARRANTIES CASH DOWN: The above-described vehicle sold by Seller is sold as is,without UNPAID BALANCE: either express or implied warranties of any kind by Seller,including :'_ 91 4 _ 1 warranties of merchantability or fitness and Buyer will bear the entire TRADE IN VEHICLE(S) INDICATES THE FOLLOWING NOTATIONS: expense of repairing or correcting any defects that presently exist or [ ]RECONDITIONED [ ]FLOOD DAMAGED may occur in the vehicle,unless a written warranty by,or service [ ]SALVAGE [ _R,[NONE OF THE ABOVE contract with Seller covering the described vehicle is delivered to I/WE WILL PROVIDE A CLEAR TITLE TO TRADE-IN VEHICLE(S)WITHIN Buyer in conjunction with or within 90 days following the time of 72 HOURS. sale,but such vehicle or any of it component parts may be subject to warranty.by th- �► ufactur r thereof. Signature X Purchas. NOTES: Co-Purchaser'sSignature Date_1!Ji .,:ta13 Dealer Name : TiYT . S('UTIi P: AT 'ti ;NTERPF'I SES Accepted By Dote 111::6/2018 Lien To: Attn: ATTIlIS DEALERSHIP: