AUTO TITLE MANUAL - Franklin County, Ohio

The undersigned hereby certifies that on the following described motor vehicle, off-highway motorcycle, or all-
Date
purpose vehicle was sold to:
Name
Street address City, state, ZIP code
Motor Vehicle, Off-Highway Motorcycle or All-Purpose Vehicle
Year Make Model Body type
Vehicle indentification number (VIN)
Purchase price $
And further certifies that said motor vehicle, off-highway motorcycle or all-purpose vehicle will be delivered to the purchaser outside
the territorial limits of the state of Ohio at pursuant to the terms of the agreement pertaining to this sale.
State
(Evidence of such delivery must be available for inspection upon request by the tax commissioner or the commissioner’s agents.)
I hereby declare under penalties of perjury that this statement has been examined by me and, to the best of my knowledge and
belief, is a true, correct and complete statement.
Dealer’s name License number, if any
Signature Title
Date
Statement Regarding Sale of a Motor Vehicle,
Off-Highway Motorcycle or All-Purpose Vehicle in Interstate Commerce
To be prepared in triplicate. Original to be retained by the vendor with two copies to the clerk of courts.
STEC IC
Rev. 3/04