STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
BILL OF SALE AFFIDAVIT
(Must Be Typed or Printed in Black Ink)
Personally appeared before me
Seller
State Zip Code
day of
Yr.
MODEL
BODY TYPE
YEAR
LICENSE NO.
Street
City
who being duly sworn, deposes and says that on the
the following vehicle: MAKE
VEHICLE IDENTIFICATION NO.
was sold to
Buyer
Street
City
State
And the above described vehicle is free of all liens and encumbrances in the buyer’s name except:
Zip Code
(List here any mortgages, liens, or encumbrances)
Sale price
of
vehicle
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
%
Less
trade-in
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S
Taxable Total
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S
Federal and State law requires that you state the mileage in connection with the transfer of ownership. Failure to complete or providing a
false statement may result in fines and/or imprisonment.
I state that the odometer now reads
(no tenths) miles and to the best of my knowledge that
it reflects the ACTUAL mileage of the vehicle described herein, unless one of the following statements is checked.
CAUTION:
Read
CarefUlly
Before You Check One of the Following:
1.
I hereby certify that to the best of my knowledge the odometer reading reflects the amount of mileage in EXCESS
of its
mechnical
limits.
2. I hereby certify that the odometer reading is NOT the actual mileage. WARNING: ODOMETER DISCREPANCY.
Signature(s) of Buyer(s)
Date
Hand Print Name(s) of Buyer(s)
Sworn to and subscribed before me
at
this
day of
.
Signature of Notary Public Attesting Seller’s Signature
Print Name of Notary Public
State of
Commission Expires
Signature(s) of Seller(s)
I
Date
Hand Print Name(s) of Seller(s)
Return to:
South Carolina Department of Revenue
Division of Motor Vehicles
P.O. Box 1498
Columbia, S.C. 292 16-0024
ANY ALTERATION OR ERASURE VOIDSTHIS
DOCXJMFNT.
ORIGINALS MUST BE SUBMITTED
TO THE DEPARTMENT.
Form 403 1 (Rev.
8/94)
Made Fillable by FreeForms.com
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