Illinois Junk Vehicle Bill of Sale

Secretary of State Junk Vehicle Bill of Sale

Secretary of State Vehicle Services Department 501 S. Second St. Springfield, IL 62756 217-782-6306 www.cyberdriveillinois.com

This space for use by Secretary of State

This is not an Illinois Certificate of Title. This certificate must be completed in full.

I, current Illinois owner ________________________________________________________________________________ , whose address is ______________________________________________________________________________________ City ________________________________________________________________ Illinois ZIP Code _______________ , does hereby sell/give to ____________________________________________________________________________________ a Year __________________________ Make ___________________________ Model ___________________________ Vehicle Identification Number ______________________________________________ for the sum of $ _______________ .

I, current Illinois owner, do hereby affirm that there are no outstanding liens against the above described vehicle, that I have legal right to sell/give such vehicle and that the Certificate of Title has been lost.

Current Illinois Owner Signature __________________________________________________________________________ Purchaser Signature ____________________________________________________________________________________ Date______________________________________________________________________________________________ Note: This form is only to be used with a Certificate of Final Disposition and only a Junking Certificate will be issued.

Printed by authority of the State of Illinois. May 2005 — 3500 — VSD 658