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w The vehicle owner or authorized agent must complete the Owner Statement below. w The person who repaired rebuilt reconstructed or assembled the vehicle must complete the information on page 2 if component parts were used* w If rebuilt by the owner and component parts were used the owner must complete both the Owner Statement below and the Rebuilder Statement on page 2. w Pages 1 and 2 of this statement must be submitted with your title application* Vehicle Information Year Make Model Vehicle ...

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