TEXAS BUYER
THE VEHICLE TEMPORARILY REGISTERED WITH STATE UNDER TAG #
16R0833
EXPIRES 04-05-2010
2010 FORD
VIN 1FAPP5F9034K43890
SELLER: ALLEN SAMUELS DODGE
BUYER’S TAG RECEIPT – DEALER’S COPY BUYER’S TAG RECEIPT – BUYER’S COPY
THIS IS THE BUYER’S TAG NUMBER: 16R0833 EXPIRATION DATE: 04-05-2010 DATE OF SALE: 02-04-2010 BUYER’S TAG EXPIRATION DATE OF
ISSUE DATE VIN YEAR MAKE MODEL COLOR 16R0833 04-05-2010 02-04-2010
02-04-2010 1FAPP5F9034K43890 2010 FORD F150 BLACK NUMBER: DATE: SALE:
Issuing Dealer Dealer Number
ALLEN SAMUELS DODGE P12345
Owner #1 Name Owner #1 Address ISSUE DATE VIN YEAR MAKE MODEL COLOR
JOHN DOE 1234 ANYWHERE LANE
Owner #2 Name Owner #2 Address 02-04-2010 1FAPP5F9034K43890 2010 FORD F150 BLACK
Issuing Dealer Dealer Number
I acknowledge that I have been given a copy of temporary tag laws form ALLEN SAMUELS DODGE P12345
entitled “Notice To Buyer”. Owner #1 Name Owner #1 Address
JOHN DOE 1234 ANYWHERE LANE
. . Owner #2 Name Owner #2 Address
Buyer’s Signature Date