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Eet) YEAR VEHICLE DESCRIPTION RESIDENT ADDRESS (City or Town) MAKE (State) (Zip Code) MODEL VEHICLE IDENTIFICATION NUMBER (VIN) I (WE) CAME INTO POSSESSION AND OWNERSHIP OF THE ABOVE DESCRIBED VEHICLE AS FOLLOWS (Include name of prior owner, seller, or transferor) OWNERSHIP STATUS TO THE BEST OF YOUR KNOWLEDGE, ARE THERE ANY LIENS OR ENCUMBRANCES ON THE ABOVE DESCRIBED VEHICLE? NO YES (If "YES", indicate names and addresses below) LIEN STATUS OATH AND ACKNOWLEDGMENT I (we) are t.

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