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HomeMy WebLinkAbout*Other - BOCCGRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT:BOCC REQUEST SUBMITTED BY:B Vasquez CONTACT PERSON ATTENDING ROUNDTABLE:B Vasquez CONFIDENTIAL INFORMATION: ❑YES ®NO DATE. 9/3/25 PHONE: 2928 log W]U0 amppill"T E]Agreement / Contract 11AP Vouchers ElAppointment / Reappointment EIARPA Related 7 Bids / RFPs / Quotes Award E]Bid Opening Scheduled El Boards / Committees 0 Budget El Computer Related E]County Code ElEmergency Purchase D Employee Rel. F-1 Facilities Related ElFinancial E]Funds ElHearing [I Invoices / Purchase Orders F-1 Grants — Fed/State/County []Leases EI MOA / MOU El Minutes ElOrdinances [I Out of State Travel [:]Petty Cash El Policies El Proclamations [:]Request for Purchase 7 Resolution 7Recommendation 0 Professional Serv/Consultant E]Support Letter E]Surplus Req. =ax Levies ElThank You's E]Tax Title Property EIWSLCB 91yaq] v 911 g ius jm4m§ M Approval for the Chair of the Board to sign a Vehicle/Vessel Bill of Sale for a 2010 Ford Edge used by the Mailroom Clerk. This transfer is from Public Works to the Commissioner's Office. If necessary, was this document reviewed by accounting? 7 YES El NO © N/A If necessary, was this document reviewed by legal? ❑ YES 1:1 NO 7 N/A DATE OF ACTION: _C?­ DEFERRED OR CONTINUED TO: WITHDRAWN: APPROVE: DENIED ABSTAIN D1: D2- lvx- RECENED D3- SEP - 3 2025 4/23/24 GRANT COIiNTY COMMISSIONERS WASHINGTOR STATE DEPARTMENT OF d*L LICENSING Vehicle 7 Please type or print plainly Vehicle Title Application Permit number Lease— Plate transfer— number: Title purposes only_ Vehicleidentification no (VIN) Condition Vehicle type Use type Fuel type 2FMDK4GC7ABB46457 New X Used Automobile Exem t Gasoline Model year Make Model Trim Body Style Motorcycle style 2010 FORD EDGE SE Sport Utility GV Weight Rating Scale wt Gross weight Mo GVVT Seats Tri axles Color #1 Color #2 Equip no Purchase price 1 47288 $0.00 Wheels Rental no 1 Fleet Engine (MC) Motor home/Cycle/WATV eng serial no Length Width Quick title Discover pass Park donation 14 1 X No X No I X No Registered owner — For additional owners, attach sheet with name, driver license/ID/TIN/E[N/UBI number, expiration date, and phone information. Washington primary residence street address or Washington principal place of business street address is required on the vehicle record. For excer)tions. see Primary Residence Address Exceotion. form 420-004. lOwner type Registered ID type Tax id Number Driver license/ID/T]N/E[N/UBI no 916001319 Expiration date Phone type (Area code) Phone no Registered owner full name (Last, First, Middle, Suffix) or Business name GRANT COUNTY Washington primary residence address (if an individual) or Washington principal place of business address (if a business) 35 C ST NW EPHRATA WA 98823-1685 Mailing address, if different than residence address (Street address or PO Box, City, State, ZIP code) or exception address One-time mailing address, if applicable JEmail address JPaperless renewal option- Notify'me by email when it is time to renew my vehicle Owner type Joint Tenants w/ ROS (JTWROS) X No ID Type Driver license/1D/TIN/EIN/UBI no Expiration date (Area code) Phone no Registered owner full name (Last, First, Middle, Suffix) or Business name Legal owner/l ien holder — Fill out if different than registered owner. For additional legal owners/lienholders, attach sheet with name, driver license/ID/TIN/E[N/UBI number, expiration date, and address information. IName of legal owner/I ien holder (Last, First, Middle initial or Business name) Legal owner/Lienholder type JID type Driver license[ID/TIN/EIN/UBI no Expiration date ELT participant X No IMailing address (Street address or PO Box, City, State, ZIP code) Dealer Dealer type Dealer no Dealer name Sale date Delivery date Vehicle status 103-Sep-2025 New X Used Prev titled I certify that this information is correct. The vehicle is clear of encumbrances except as shown. Dealer authorized signature Any required sales tax has been collected. X Anyone who knowingly makes a falsNstatement may be guilty of a felony under state law and upon conviction shall be punished by a fine, mprisonmell, o I certify under enalty of perjury under the laws of the state of Washington that the foregoing is true and correct. X X . Signatu e'6f r isAred owner Title, if signing for business Signature of registered owner Title, if signing for business Date and place signed Date and place signed Notarization/Certification - You don't need your signature notarized if you sign in front of a WA vehicle licensing agent, who can certify your signature. State of Signed or attested before me on Title County of by Name of person signing this document Notary/Agent/Subagent signature Printed or stamped name and Dealer or county/office number or notary expiration date s1 -�:_. .,�� 4-� .�-1.1..-.. .....!y..,..,-I; , !.-11! r S i '� t'�, .... 1.-.-... _.-... i�', :'.:-.. . , ." I .. .­ ­.... �.I � . --. .I.1. -.I �� .­I_­�I1_.�,-.. .�..1.­...1.... ... -'.... . *­.. , ..�.­ T._.-.. . N�_.:..­;,, .-..�...1' ,� .-. 1:. .:.­_,-.-.-I .­- ­­.-" i" F :S�f.H'­._.u_,II -.­-�' �1 �...._..... G. .'..... .1..I.0. ,w....4...-.e A.. .� ....­.�­:-.. . . , �. --� - ­ .­.­. ..-. I;. 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LICENSING Vehicle/Vessel Bill of Sale Use this form to gather necessary information when you sell your vehicle or vessel. Completing this form does not transfer the title or act as a Report of Sale. To complete the transaction, the buyer and seller have the following responsibilities: Seller Remove license plate from the vehicle at time of sale. Submit a completed Report of Sale within 5 days from the date of sale. The Report of Sale releases your liability from the vehicle or vessel. You can report the sale: In person at any vehicle licensing office (vehicles only). Fees apply. Online (vehicle only) at dol.waQeev. Mail a Vehicle Resort of Sale or Vessel Report. of Sale. Include required fee in a check or money order, made payable to Department of Licensing. Buyer To apply for a new title, take the Certificate of Title and this Bill of Sale to any vehicle licensing office and pay all fees and taxes. You must apply within 15 days of acquiring the vehicle/vessel or you may pay a late fee. Late transfer fees start at $50 and increase to a maximum of $125. NOTE: Depending on your specific situation, other forms may be necessary. For more information, contact customer service at 360.902.3770. Forms are available online at dol.wg.gov or at any vehicle licensing office. Vp-hiclp/Vassall information Sale of (choose one) License plate/ Registration number Vehicle identification number (VIN)/Hull identification number (HIN) Vehicle D Vessel 94253C 2FMDK4GC7ABB46457 w Model year Make Model Date of sale Sale price 2010 FORD EDGE GIFT SP-11pr information Seller names GRANT COUNTY PUBLIC WORKS Seller address 124 ENTERPRISE ST SE City State ZIP code EPHRATA WA 98823 1 Ruver information - -- up - - ---- - - - - - Buyer names GRANT COUNTY Buyer address 35 C ST NW City State ZIP code EPHRATA WA 98823 Relationship ? 0 Yes Ej No Are you an immediate family member receiving this vehicle as a gift? If "Yes," what is your relationship to the seller? "ell Buyer � a� �. X Buyer signature RCW 46.12.650 WAC 308-56A-024 Se gnature I X V19 Seller signature TD-420-065 (R/4/24)VWA WASHINGTON STATE DEPARTMENT OF California Emissions Compliance deL LICENSING Exemption Certification You can use this form to title and/or register a vehicle when you do not have the Manufacturer's Certificate of Origin. Model year 2009 and newer passenger cars, medium duty passenger vehicles, and light -duty trucks must have been manufactured to meet California emissions standards to be registered in Washington. After completing and signing this. form, turn it in to any vehicle licensing office with a Title/Registration Application. • This form is only required for model year 2009 and newer passenger cars, medium duty passenger vehicles with a gross vehicle weight rating less than 10,000 pounds, and light -duty trucks with a gross vehicle weight rating 8,500 pounds or less in the absence of a Manufacturer's Certificate of Origin. • Write the vehicle year, make, model, and vehicle identification number (VIN) in the space provided for the vehicle you want to register. • Check the box(es) listed below that describe the vehicle you want to register. • Read the certification statement, then print and sign your name. Under hood emission label An emission label can be found permanently affixed under the hood of every vehicle. This label will have the following, or similar, wording indicating the vehicle conforms or is certified to California emission standards: - • For a California -only vehicle: This vehicle conforms to U.S. EPA and California regulations applicable to 2009 model year new motor vehicles introduced into commerce only for sale in California. For a 50-state vehicle: This vehicle conforms to U.S. EPA and California regulations applicable to 2009 model year new motor vehicles. For a federal vehicle certified for sale in California: This vehicle conforms to U.S. EPA regulations applicable to 2009 model year new motor vehicles, and is certified for sale in California. VERCUIEMISSWRONTAOIL, INV MATIONI, ENGINE FAMILY EFN 2.SVBT2EA OBD 11 DISPLACEMENT 2.8 L CERTIFIED THIS VEHICLE CONFORMS TO U.S. EPA AND STATE OF CALIFORNIA REGULATIONS APPLICABLE TO 2008 MODEL YEAR NEW LEV PASSENGER CARS REFER TO SERVICE MANUAL FOR ADDITIONAL INFORMATION TUNE UP CONDITIONS: NORMAL OPERATING ENGINE TEMPERATURE, ACCESSORIES OFF, COOLING FAN OFF, TRANSMISS16N IN NEUTRAL EXHAUST EMMISSIONS STANDARDS STANDARD CATEGORY CERTIFICATION TLEV IN USE TLEV INTERMEDIATE SPARK PLUG CATALYST EFN 2.8V82TEA Type NGK BRFES-1P GAP 1.1 mm While the above examples refer to "2009," the year shown on the label of your vehicle will match your vehicle's model year. 0 Vehicle year 0 Make Model 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 VIN IS f Emissions compliance certification IS-L-il certify this vehicle complies with California emissions standards. There is evidence of compliance on the vehicle's under -hood emission label. (VVAC 173-423-070) Emissions exemption certification Military Tactical Vehicle I Vehicle sold for registration out of state (Vehicle will not be registered in Washington) L Rental vehicle —Final destination outside of Washington Emergency vehicle exempted by Department of Ecology Gross Vehicle Weight Rating over 10,000 pounds (passenger vehicles only) L.-_1 Gross Vehicle Weight Rating over 8,500 pounds (truck -type vehicles only) f Vehicle has more than 12 seats (including driver) Vehicle has more than 9 seats behind driver I purchased this vehicle before becoming a Washington resident I acquired this vehicle by inheritance I acquired this vehicle by divorce, dissolution, or legal separation Vehicle was registered in another state/jurisdiction and the mileage on the odometer was over 7,500 miles at the time of the private sale or at the time of acquisition by a vehicle dealer declare under penalty of perjury under the law of Washington that fie oing is true and correct. I e 01 t ,ZtbA PRINTa icant name X Date and place Signatufe Washington State law makes it clear that it is a felony to knowingly make a false statement of fact. The penalty, upon conviction, shall be a fine of not more than $5,000 or by imprisonment for not more than ten years, or both the fine and imprisonment. (RCW 46.12.210) TD-420-539 (R/6124)WHA Registration Certificate Model Year Make Model Body Style Vehicle identification number (VIN) Scale Weight 2010 FORD EDGE Sort Utility 2FMDK4GC7ABB46457 41288 iif�; � ; c �� • c 1 �,. f Plate/Tagno Tab/Decal no Prima vehicle use e Issue date Ex date ` Primary type R F itr r�T � r�.l E7953C Exempt 09/15/2025 Perm�S, e fff , , Plate/Tagno Tab/Decal No Vehicle use e Issue date Ex date type R Gross Weight Gr wt start date Gross weight exp date Fleet no Equip no ► , Piz -- �ifcl�il if�ltifl i` fP' Q1 st'tfi 1,rFi tr Registered Owner GRANT COUNTY Legal owner Same as Registered Owner 3rands/Comments: 28770/2010, Exempt (County), Use Tax Waived -Gift, Display tab on back license plate only -front plate is still equired Anyone who knowingly makes a false statement may be guilty of a felony under state law and upon conviction shall be punished by a fine, imprisonment, or both t certify under penalty of perjury under the laws of the state of Washington that the foregoing is tree and correct and, as owner or authorized agent of the vehicle,.. it is free of any claim of lien, mortgage, conditional sale or other security interest of any person except the person or persons set forth as legal owners. Signature of registered owner Date and place signed X Signature of registered owner Date and place signed L0281456316 ,ram -----.-----._.._..--.------__--. The following section may be removed for address privacy. Vehicle Information: E7953C 2FMDK4GC7ABB46457 2010 FORD EDGE Sport Utility You can get a copy of this cash/fee receipt detail at www.dol.wa.gov/fee-history Issue Date: 09/15/2025 Fee Category Amount Title $21.50 Plate $6.00 Administration $33.75 Fee Total $61.25 GRANT COUNTY 35CSTNW EPHRATA WA 98823-1685 Skip a trip — go online www.dol.wa.gov