HomeMy WebLinkAboutPR 24668: DONATION OF A 2026 FORD EXPLORER FROM THE TEXAS DEPT. OF HEALTH AND HUMAN TO BE UTILIZED TO PROVIDE WIC SERVICES OUTSIDE OF THE CLINIC City of
n r I 1-Ili It
Date: November 20, 2025
To: The Honorable Mayor and City Council
Through: Ron Burton, City Manager
From: Judith A. Smith, RN, BSN, Director of Health Services
RE: P.R. 24668 Approval to execute all necessary documents for the donation of a 2026 Ford
Explorer from the Texas Department of Health and Human to be utilized to provide WIC
services outside of the clinic. This vehicle is donated and there is no cost to the City.
Nature of the Request: Recently, because of surplus funds from fiscal year 2025, the Texas
Department of Health and Human Services WIC Program was able to purchase vehicles for
WIC business,and the city of Port Arthur's WIC program will be the recipient of one of the vehicles.
The 2026 Ford Explorer will be used to provide WIC services at hospitals, outreach events, and
WIC related travel. All vehicle maintenance, inspections, and repair services will be funded by the
WIC Vehicle Maintenance Acct. 101-23-061-5319-00-50-000, HG26O3.GRE.MVM.
Staff Analysis, Considerations:No additional staff needed. The WIC staff will use this van to
provide WIC services within the community.
Recommendations: It is recommended that the City Council approve P.R. No 24668,which is the
acceptance of the donated 2026 Ford Explorer from Texas Department of Health and Human
Services to the City of Port Arthur WIC Program.
Budget Considerations: The value of the Ford Explorer is $42,834.67 and has been funded by
the Texas Department of Health and Human Services. All funds necessary for vehicle
maintenance will be paid for by WIC grant funds.
"REMEMBER IWE ARE HERE TO PER VE THE CITIZENS OF PORT ARTHUR P.O. BOX 1089- PORT ARTHUR, TX 7764 1-1 08-9
409/983-.8101-FAX 409A82.6243
P.R.No. 24668
11/21/2025-JS-T'NR
RESOLUTION NO.
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
EXECUTE ALL NECESSARY DOCUMENTS TO ACCEPT THE
DONATION OF A 2026 FORD EXPLORER FROM THE TEXAS
DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR USE BY
THE CITY OF PORT ARTHUR WIC PROGRAM. INSPECTIONS AND
REPAIR SERVICES WILL BE FUNDED BY WIC GRANT FUNDS,
VEHICLE MAINTENANCE ACCOUNT, 101-23-061-5319-00-50-000,
HG2603.GRE.MVM
WHEREAS, the Texas Department of Health and Human Services' WIC Program realized
surplus funds at the conclusion of Fiscal Year 2025 and, as a result,purchased vehicles to support
local WIC clinics in delivering program services throughout their communities; and
WHEREAS,the City of Port Arthur WIC Program has been selected as a recipient of a
donated 2026 Ford Explorer, with an assigned value of$42,834.67,to support program operations;
and
WHEREAS,the vehicle will be used by WIC staff to provide services at hospitals, outreach
events, and for other WIC-related travel throughout the community; and
WHEREAS, all inspections, repairs, and maintenance associated with the vehicle will be
funded through WIC grant funds, specifically the WIC Vehicle Maintenance Account No. 101-23-
061-5319-00-50-000 (HG2603.GRE.MVM); and
WHEREAS, the Director of Health recommends acceptance of the donated vehicle and
further recommends authorizing the City Manager to execute all documents necessary to effectuate
the donation.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF PORT ARTHUR, TEXAS:
Section 1. The facts and opinions in the preamble are true and correct.
Section 2. The City Council hereby approves the acceptance of the donation of one (1)
2026 Ford Explorer from the Texas Department of Health and Human Services for use by the City
of Port Arthur WIC Program, as further described in Exhibit"A."
Section 3. The City Manager is hereby authorized to execute all documents necessary to
accept and place the donated vehicle into service for the WIC Program.
P.R.No.24668
11/21/2025-JS-TNR
Section 4. That, a copy of the caption of this Resolution be spread upon the Minutes of
the City Council.
READ, ADOPTED, AND APPROVED, this day of
2025 at a Regular Meeting of the City Council of the City of Port Arthur, Texas, by the following
Vote: AYES:
Mayor:
Councilmembers:
NOES:
Charlotte M. Moses, Mayor
ATTEST:
Sherri Bellard, City Secretary
APPROVED AS TO FORM:
Roxann Pais Cotroneo, City Attorney
4
P.R. No. 24668
11/21/2025-JS
APP ED AS T• FUNDS:
,-I //
Lynda Boswell, MA,ICMA-CM, 6 irector of Finance
APPROVED FOR
ADDMMINISTRATION:
4Nlir 14"11
Ron Burton, = ' , C t ''* anager Jud Smith, R.N. BSN, Director of Health
EXHIBIT "A"
•
0Acommunity
PARTNERSHIP
Helping People. Changing Lives. Administrative Office
South Plains Community Action Association,Inc (800)782-5028
411 Austin P.O.Box 610 Levelland TX 79336 (806)894-6104 FAX(806)897-0852
November 19, 2025
WIC Program
City of Port Arthur
Dear WIC Director,
As part of SPCAA's contractual agreement with HHSC State WIC, SPCAA purchased a 2026 Ford
Explorer,VIN#1FMUK7DH4TGA15242,with a purchase price of$42,834.67.
SPCAA obtained written approval from the State WIC office and USDA prior to this purchase.The unit
was purchased with USDA funds under WIC FY 2025, in compliance with WIC policies, UGMS, and 2
CFR Part 200.
With the approval of the State WIC office,this unit is gifted to Port Arthur WIC,and will be
titled directly to the recipient upon delivery. Ongoing obligations of your entity include: reporting the
unit on the required WIC GC-11 inventory report, insuring, maintaining, and using the vehicles in
accordance with the WIC program.
Please contact SPCAA if further information is needed.
Sincerely,
bottotoutki
ov
Whitney Quick, CPA
Finance Director
•
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5860 911 AVE.
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SHIP TO:
SMITH AUTO FAMILY
2483 ESTATE ROAD 114
LEVELLAND TX 79336-9236
.:; TX 794 0-01
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SIGNATURE REQUIRED
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304928
ODOMETER DISCLOSURE STATEMENT
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 in fines and/or
imprisonment.
1 SMITH AUTO FAMILY LEVELLAND state that the odometer now
(TRANSFEROR'S NAME•PRINT)
reads i i (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) I hereby certify that to the best of my knowledge the odometer reading
reflects the amount of mileage in excess of its mechanical limits.
I (2) I hereby certify that the odometer reading is NOT the actual mileage.
WARNING - ODOMETER DISCREPANCY.
MAKE FORD
MODEL
EXPLORER TYPE VEHICLE
4DR SUV
IDENTIFICATION NUMBER 1 FMUK 7 DH 4 1 GA 1 5 2 4 2
YEAR 2026
TRANSFEROR'S NAME SMITH AUTO FAMILPgiNTED LEVELLAND
2483 E STATE HWY114
(STREET)
TRANSFEROR'S ADDRESS
LEVELLAND TX 79336
(CITY) (STATE) (ZIP CODE)
TRANSFEROR'S NAME X (SIGNATURE)
DATE OF STATEMENT NOVEMBER , 2025
TRANSFEREE'S NAME CITY OF PORT ARTHUR WIC DIVISION
CRfO 9T14 AVF
(STREET)
TRANSFEREE'S ADDRESS
PART ART?-ITIR • Y;Y; 7.76'42
(CITY) (STATE) (ZIP CODE)
TRANSFEREE'S NAME X (SIGNATURE)
!..TTV n7 P')RT APTHIM
(PRINTED NAME)
DIVISION
DS-621 Order From DEALERS SUPPLY CO.
PHONE 1-800-521.3870 FAX 1-800-537-6031
www.dealersupply.com
NATIONAL VEHICLE SERVICE CONTRACT LINCOLN(I)
APPLICATION, TERMS & CONDITIONS
(Excludes Medium Duty, Incomplete and Diesel EngineCARE plans)
PROTECT
Vehicle Identification Number("VIN")(17 Digits) Signature Date Warranty Start Date FBA/L-CPO Upgrade Plans
1FMUK7DH4TGA15242 11/18/2025 11/18/2025
FBA Gold
Internet Sale IPP IPP Term Current Mileage
11 FBA Blue
Surcharges: L-CPO
12 Months/12,000 Miles Snowplow !Xi Commercial Use
Non-CPO Wraps
36 Months/36,000 Miles or 48 Months/50,000 Miles(Lincoln Vehicles)
Specialty-Emergency(Fire,Ambulance,Police(Non-Ford),Limo,Livery,Shuttle,Tow Truck) ' Powertrain
New Plan Coverage:Coverage begins at Warranty Start Date and Zero Miles
• Mechanical or FBA Gold Upgrade-PremiumCARE,ExtraCARE,BaseCARE,PowertrainCARE(Standard Deductible is$100)
• L-CPO(Lincoln)-PremiumCARE(Standard Deductible is$100)
• PowertrainCARE Wraps-(Standard Deductible is$100)
• LeaseCARE-New PremiumCARE with Wear Items(Standard Deductible is$0)
• RentalCARE-(Standard Deductible is$0)
Used Plan Coverage:Coverage begins at Signature Date and Current Miles
• Mechanical-PremiumCARE, ExtraCARE,BaseCARE,PowertrainCARE(Standard Deductible is$100)
• FBA Blue Upgrade-PremiumCARE,ExtraCARE,BaseCARE,PowertrainCARE(Standard Deductible is$100)
PLAN COVERAGE Plan Term Plan Expiration-(Earliest of) Purchase Sales Tax Total Purchase Price Price
Deductible I with Sales Tax '
X,New 'Used I Months Mileage Date Mileage
Premiumcare-New
I $100 60 100000 ; 11/18/2030 100000 $ 3070.00 $ 0.00 $ 3070.00
Options: Pick Up&DEnhanced' Delivery/ _;Key Services Delete ' _. Interior/Exterior Lighting Delete � First Day Rental Delete Rental Delete
Mobile Service
DISCLOSURE INFORMATION:
THIS IS NOT AN INSURANCE CONTRACT. 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.
I have read this Agreement in its entirety and specifically acknowledge the provisions pertaining to My duties relating to required maintenance of the
Covered Vehicle;the duty to prevent further loss;how to obtain service and any required documentation I must keep;the parts and services
covered;applicable time or mileage limitations;exclusions;and my right to return this Agreement and receive a refund. The implied warranty of
merchantability on the covered vehicle is not waived if You purchased this Agreement within 90 days of the purchase of the covered vehicle and We
or the Selling Dealer also sold the Covered Vehicle.
Contract Holder Initials( CW )
SERVICE CONTRACT HOLDER/PURCHASER
Name For Terms and Conditions,visit our webpage at
CITY OR PORT ARTHUR WIC DIVISION https://fordprotect.ford.com/fplp-8250-nat-w-keyl'
or scan the OR R code below.
Signature(Not Valid without Signature) Signature Date
11/18/2025
Address(City/State/Zip Code) •
. 111•1115860 9TH AVE PORT ARTHUR TX 77642 1 .�.��
• r.� •
Customer's E-Mail Address
t
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Service Contract Lienholder Name ❑ `�'1,•r •
DEALERSHIP INFORMATION
Dealership Sign
Dealer Name ' Telephone No
Smith South Plains Ford Lincoln
Address(City/State/Zip Code)
2483 TX-114 Levelland TX 79336
Employee Stars Id P&A Code 0 3 5 5 3
FPLP 8250 - NAT W/KEY (OCT 2023)
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CITY OR PORTARTHUR, Review The Products You've Selected And Excellent Options You
May Miss Out On
Review and confirm your Final Acceptance and Declination of the products we offer below
Accepted Coverage Declined Coverage
Ford Protect Comm Mechanical SurfaceCARE
rig -EiMI'J MCARE-NEW Coverage o i Pr tea t mte.I b;I
�; maintain the k ea,.-.,I ,r f I r,rotect
00 months/100,000 i ales TermrMi ,.;c and our.•S 1,a95.00 Total
IOC DECUCT!BLE Deductible .
53,07000 Price ' Maintenance
Performs maintenance at scheduled.intervals.Saves
money purchased ahead r r.,Ic c+ h. ir, ea.,
epara:teiv.-$3,545.00 Total
TireCARE
Ford Protect TireCARE offers protection from the hazard•
•
;itire
s or wheels become damaged as a
result of[living over debris,such as rails,glass or metal cr
you nave a blov,o'rt,Ford Protect Tlre,.ARE will herip you
:rr,}i, B'a;;? •;dr.n=pairs.•S760.00 Total
TripleCARE
e. r tr r pt,duCt pr:',-0.1.2S coverage
for ,r ,f I v e.l damage, minorr dents
and.M.,cr v' q Si.,moor .; i cracks to'vow front
hi.ld-$1,030.00 Total
r t is �t
Acknowledgement
I hereby certify that the above product/services were presented and either accepted or declined at my own discretion.I understand they are being
offered in conjunction with my vehicle transaction and may or may not be available afterward as stand-alone products.I recognize that the above
accepted products/services equal a Payment of$42,834.67
Electronic Communication Authorization
ra Opt Out
To provide the highest level of service to our customers,Smith South Plains Ford Lincoln would like to be able to contact you in order to remind you
of necessary maintenance and service your vehicle will need,to conduct quality control,to make sure you are happy with your purchase,or to keep
you informed of new product offerings and promotions. By signing below, you acknowledge that you have read this disclosure and give us
permission to contact you at the telephone number,cell phone number,or email address listed.By signing you give us permission to call,email,and
text message. Methods of contact may include using pre-recorded/artificial voice messages and/or the use of an automatic dialing device, as
applicable.This authorization allows us to better serve you in compliance with federal and state do-not-call regulations.You are not required to give
this authorization as a condition of this transaction.Please check the Opt Out box to be removed from future communications.
Buyer Signature Date
FACTS WHAT DOES Smith South Plains Rev. 0412020
DO WITH YOUR PERSONAL INFORMATION?
Financial companies choose how they share your personal information.Federal 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
r information.Please read this notice carefully to understand what we do.
'44 � r k The types of personal information we collect and share depend on the product or service you have with us.This
�, information can include:
s=, � Va i • Social Security number and Date of Birth
--- � "`z ■ Drivers License and Address
■ Phone Numbers and Bank Account Information
When you are no longer our customer,we continue to share your information as described in this notice.
� s All financial companies need to share customer's personal information to run their everyday business.In the section
, ' below,we list the reasons financial companies can share their customer's personal information;the reasons Smith South
M " `; -k Plains chooses to share;and whether you can limit this sharing.
m
For our everyday business purposes—
such as to process your transactions,maintain your account(s), YES NO
respond to court orders and legal investigations,or report to credit
bureaus -- __T_
i For our marketing purposes— YES NO
to offer our products and services to you
For joint marketing with other financial companies
YES j NO
For our affiliates'everyday business purposes— f YES NO j
information about your transactions and experiences
-
For our affiliates'everyday business purposes— YES i NO
information about your creditworthiness
For our affiliates to market to you YES NO
For nonaffiliates to market to you YES I NO
Call 8068943191 or go to smithsouth lains.com
F Y h
i
Who is providing this notice? 1 Smith South Plains
How does Smith South Plains ' To protect your personal information from unauthorized access and use,we use security measures
protect my personal information? that comply with federal law.These measures include computer safeguards and secured files and
1 buildings.
I How does Smith South Plains We collect your personal information,for example,when you
collect my personal information? • apply for credit or purchase parts i
■ have service repairs or have body shop repairs
• request information online
Why can't I limit all sharing? Federal law gives you the right to limit only
i ■ sharing for affiliates'everyday business purposes—info about your creditworthiness
■ affiliates from using your information to market to you
■ sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to limit sharing.
Affiliates Companies related by common ownership or control.They can be financial and
nonfinancial companies.
■ SSP QL LLC
Nonaffiliates Cormbanies not related by common ownership or control.They can be financial and
nonfinancial companies.
■ For Example:Ford Credit,Ford Direct,AutoFi,Wells Fargo,Ally,JPMorgan
Chase Bank,Exeter,Santander
Joint marketing A formal agreement between nonaffiliated financial companies that together market
financial products or services to you.
• For Example:Ford Credit,Ford Direct,AutoFi,Wells Fargo,Ally,JPMorgan
Chase Bank,Exeter,Santander
I hereby acknowledge I have received a copy of this Privacy Notice from Smith South Plains.Acknowledgment of Receipt:
Customer Signature
Crtp of ).;•tr- Ai}i rft-., L(....,t� tj4). Printed Name ti /i4 /1 J Date
RECALLL DISCLOSURE FORM
Seller 6MITH . ��? ,FAMrr 4ii ; ND
LSTATE� :bi�
.,J LLr
Seller's Address • �r71J 3 3•? Pone�� �t�` ' ?
v.
Buyer`T OF PORT A .i. i? WIC DIVISION Buyer's Address AFD-I R Tx 7 64
Buyer's Phone: Cell Home 379% 595-28°^Business y7� ASS =j ���Email RCN1 Ct FORT
I give my permission to Seller to contact me on any of the above listed numbers,by text message,and by email.
ML' - Tr " r Yam' 202 2c T 5
VIN .j"'A'``� �-,� Y_` '`�"`��� Make =�'� Model r.:�:s:1P�? Year ' O Stock E' �=
The above-described vehicle is subject to the following recall:
Attached are the following,if available:
1.Print out from the National Highway Traffic Safety Administration's (NTSA)website),
www.safercar.gov for this vehicle.
2.Information from the manufacturer of 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.
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 form and any attachments were disclosed and given to me prior to my signing any
purchase agreement or retail installment contract.
I agree to disclose the above information to the next buyer.
Date ,L1y - 'O2
Buyer's Signature
Date . 1 2
Seller's Signature
NOTARY COMPLETION OPTIONAL
State of Texas
County of ;r• in
This instrument was signed before me on(date)
by
Notary Signature
Notary Stamp
1
Application for Texas Title and/or Registration
Applying for(please check one): TAX OFFICE USE ONLY
❑Title&Registration ❑Title Only ❑ Registration Purposes Only 0 Nontitle Registration County:
For a corrected title or registration,check reason: ' Doc#i
0 Vehicle Description 0 Add/Remove Lien ❑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
r M? rK 7 DH jj,TC5 5 2 0.,
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 any)
i ❑Not Actual 0 Exceeds Mechanical Limits 0 Exempt
13.Applicant Type 14.Applicant Photo ID Number or FEIN/EIN
❑ Individual 0 Business ❑Government 0 Trust 0 Non-Profit
15.ID Type 0 U.S.Driver License/ID Card(issued by: ) 0 NATO ID 0 U.S.Dept.of State ID
❑ Passport(issued by: ) ❑ U.S.Military ID ❑ U.S.Dept.of Homeland Security ID
❑ U.S.Citizenship&Immigration Services/DOJ ID 0 Other Military Status of Forces Photo ID
16.Applicant First Name(or Entity Name) Middle Name - Last Name Suffix(if any)
CITY' 0 _ »y / I ., DIVISION
17.Additional Applicant First Name(if applicable) Middle Name Last Name Suffix(if any)
•
18.Applicant Mailing Address City State Zip 19.Applicant County of Residence
5850 i i 1s .AVE LCP ."L.�
� . t+..JT.X -7:542
20.Previous Owner Name(or Entity Name) City State 21.Dealer GDN(if applicable)22.Unit No.(if applicable)
SMITxH. A1.7O inz'�iL�i i i:.�♦i�ai% I.O FILLANT TX _8 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 28.Communication Impediment?
9 7 9 ' 5 9 5-2 8 0 0 R 7,FLJ81013@E0RT.P0I1-'.TJR.i' .2 V 0 Yes(Provide Email in#26) 0 Yes(Attach Form VTR-216)
29.Vehicle Location Address(if different) City State Zip
•
30.Multiple(Additional)Liens 31.Electronic Title Request 32.Certified/eTitle Uenholder iD Number(if any) 33.First Lien Date(if any)
0 Yes(Attach Form VTR-267) 0 Yes(Cannot check#30)
34.First Lienholder Name(if any) Mailing Address City State Zip
35.Check only if applicable: MOTOR VEHICLE TAX STATEMENT
❑ I hold Motor Vehicle Retailer(Rental)Permit No. and will satisfy the minimum tax liability(V.A.T.S.,Tax Code§152.046(c1)
❑ I am a dealer or lessor and qualify to take the Fair Market Value Deduction(V.A.T.S.,Tax Code,§152.002[0.GDN or Lessor Number
36.Trade-In(if any) Year Make Vehicle Identification Number 37.Additional Trade-In(s)
❑ Yes(Complete) 0 Yes
38.Check only if applicable: SALES AND USE TAX COMPUTATION
(a) Sales Price($ Nj7t rebaie has been deducted) $ .36,97 ,31 p $90 New Resident Tax-(Previous State)
(b) Less Trade-in Amount,described in Box 36 above $( 1\i/A i ❑ $5 Even Trade Tax
(c) For Dealers/Lessors/Rental ONLY-Fair Market Value 0 $10 Gift Tax-Attach Comptroller Form 14-317
Deduction,described in Boii 36 above $( •'' ) '❑ $65 Rebuilt Salvage Fee
(d) Taxable Amount(Item a minus Item b or Item c) $ -"74.31 0 2.5%Emissions Fee(Diesel Vehicles 1996 and Older>14,000 lbs.)
(e) 6.25%Tax on Taxable Amount(Multiply Item d by.0625) $ ':i >° a ❑ 1%Emissions Fee(Diesel Vehicles 1997 and Newer>14,000 lbs.)
(fl Late Tax Payment Penalty ❑ 5%or 0 10% Exemption claimed under the Motor Vehicle Sales and Use Tax Law because:
(g) Tax Paid to (STATE) $ /.4.
(h) AMOUNT OF TAX AND PENALTY DUE 0 $28 or$33 Application Fee for Texas Title
(Item e plus Item f minus Item g) $ "%,. '7 (Contact your county tax assessor-collector for the correct fee.)
CERTIFICATION-State law makes falsifying information a third degree felony
I 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).I also certify
(check if applicable):0 I have physically inspected t ehicle described and verified the vehicle identification number above.0 The vehicle is unrecovered stolen,and I am
unable to verifythe vehicle i ntification num above.0 I am applying for a corrected title and the original Texas Certificate of Title is lost or destroyed.
2�,.."; 21,70 FAMILY LE,.T.vL+12ND 18/2i 2_
Signature(s)of Seller(s),Donor(s),or rader(s) Printed Name(s)(Same as Signature(s)) Date
Signature of Applicant/Owner 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 01/25 Form available online at www.TxDMV.gov Page 1 of 2
BUYERS D —EST 1952-- - -
_ 4 JTO FAMO
PURCHASER INFORMATION: SALESMAN: RAI- ' R E DATE: "'.._ - 'SIP-77
BUYER: - ar = - =._---._.='. 'TL- . ici SOCIAL SECURITY#: - - DOB: / /
CO-BUYER: SOCIAL SECURITY#: - - DOB: /
-_
,is_ CITY: -.T __.-_ STATE: ZIP: .
ADDRESS: -"' -''-
PHONE#: (H) 37'-• 232O (W) _ _3E-L'� . (W)
EMAIL: - _. "',
PURCHASED VEHICLE: SELLING PRICE: -d . - ,
YEAR: '` ` MAKE: '7 TRADE ALLOWANCE:
-- MODEL: -- .- i`,
BODY STYLE. ==a--= - MILES: i ; REBATE:
TRADE DIFFERENCE:
SALES TAX: 2 , .2i10 . - -
COLOR: ' `- = LICENSE PLATE# .-
LICENSE FEE: ; �,�; , ;
TRADE-IN VEHICLE: TITLE FEE: - -
YEAR: MAKE: MODEL: STATE INSPECTION:
BODY STYLE. MILES: `
DEALER INVENTORY TAX: 34 ,
VIN# DOCUMENTARY FEE: 22E. ;, ;
COLOR: LICENSE PLATE# TOTAL: `a -: - - -
LIEN HOLDER: TRADE PAY-OFF: -., _-
-A DOCUMENTARY FEE IS NOT AN OFFICIAL FEE.A DOCUMENTARY SERVICE CONTRACT: _ _- , -
FEE IS NQT REQUIRED BY LAW,BUT MAY BE CHARGED TO BUYERS CREDIT INSURANCE: T;;`
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: 4 2 ,g = ,
DISCLAIMER OF WARRANTIES CASH DOWN:
The above-described vehicle sold by Seller is sold as is,without UNPAID BALANCE: -, e:,
either express or implied warranties of any kind by Seller,including `- , ' . S
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 [ ]NONE OF THE ABOVE
contract with Seller covering the described vehicle is delivered to I� WILL PROVIDE A CLEAR TITLE TO TRADE-IN VEHICLE(S)WITHIN
Buyer in con' nction with or within 90 days following the time of I/WE HOURS.
sale,but ch v hicle or an of its component parts may be subject
to warra ty b the manufccprer thereof. Signature X
Purchas /'Vt&L/ �L NOTES:
Co-Purchase 's ignature Date Dealer Name Ni='== -- _ =0 1 A.-1_...... • __ _.__ .. _.
-Accepted By Date --- -=
Lien To:
Attn:
6T THtL nwAr F.RSHIP:
8
BUYERS ORDER -EST.1952-
_ _
'4 UTO FAMtt)
PURCHASER INFORMATION: SALESMAN: ._ DATE: - - _-
BUYER: --' _ '' ` =- '=` SOCIAL SECURITY#: - - DOB: / /
CO-BUYER: SOCIAL SECURITY#: DOB:
ADDRESS: - -._ CITY: -- STATE: -- ZIP:
PHONE#: (H) _ _ (W) _ - (W)
EMAIL: - --,
PURCHASED VEHICLE: SELLING PRICE: ,Y - .
YEAR: - MAKE: -` MODEL: =_ TRADE ALLOWANCE: _
BODY STYLE: ' ' , - MILES: REBATE:
TRADE DIFFERENCE:
SALES TAX: -
COLOR: -— — LICENSE PLATE# LICENSE FEE: - -
-, ~
TRADE-IN VEHICLE' TITLE FEE: • E.
YEAR: MAKE: MODEL:
STATE INSPECTION: ..
BODY STYLE: MILES:
DEALER INVENTORY TAX:
VIN# DOCUMENTARY FEE:
COLOR: LICENSE PLATE# TOTAL: _
LIEN HOLDER: TRADE PAY-OFF:
'A DOCUMENTARY FEE IS NOT AN OFFICIAL FEE.A DOCUMENTARY SERVICE CONTRACT: , _ _
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: _ _ _ _ -.
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 - ` '
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 [ ] 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 con nction with or within 90 days followingthe time of 72 HOURS.
sale,but ch v hide or an of its component parts may be subject
to warrantyhe manufrer thereof. Signature X
U4
Purchas
� L- NOTES:
Co-Purchase 's ignature Date '
Dealer Name _._ _ __
Accepted By Date -
Lien To:
AtIn:
AT THIS DEALERSHIP;
. . ,. c -.._.1__i_..__ .._.I-.. ..