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OWNER INFORMATION PREVIOUS OWNER CITY STATE NAME OF OWNER CURRENT ADDRESS DAYTIME PHONE NO. - ZIP CODE LIEN INFORMATION DATE OF LIEN LIENHOLDER S NAME LIENHOLDER S ADDRESS If additional liens are indicated attach an Additional Liens Statement Form VTR-267. NOTE IF LIEN RECORDED ON SUBMITTED EVIDENCE HAS BEEN SATISFIED ATTACH A PHOTOCOPY OF A PROPERLY EXECUTED RELEASE OF LIEN FROM THE RECORDED LIENHOLDER* I the undersigned hereby certify that I am the legal owner of the above described vehicle a ...

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