Keep with the vehicle at all times. - ExpressLane

1 keep with the vehicle at all times. Temporary Tag Number_____ Owner First Name_____. Type of Plate: _____ Owner Middle Name_____. VIN:_____ Owner Last Name_____. vehicle Make:_____ Business Name:_____. vehicle Body Style:_____ Owner DL Number:_____. vehicle Model:_____ Owner DL State:_____. Weight:_____ Owner Address:_____. vehicle Color Body: _____ Owner City:_____. vehicle Color Top:_____ Owner Parish:_____. vehicle Model Year:_____ Owner State:_____. Date Acquired:_____ Owner Zip:_____. Tax/Delivery Date:_____ Email:_____. Temp Tag Expiration:_____ Second Owner Business Name:_____. Electronic Fund Transfer Code:_____ Second Owner First Name:_____. Electronic lien Transfer Code:_____ Second Owner Middle Name:_____. Dln/Ein of Renter:_____ Second Owner Last Name:_____. Trade VIN:_____ Business Name 2:_____. Trade License Number:_____ Second Owner DLN:_____.

2 First Lienholder Name:_____ Second Owner DL State:_____. First Lienholder Address:_____ Second Owner Email:_____. First Lienholder City:_____ Renewal Mailed to Owner:_____. First Lienholder State:_____ Second Address Type:_____. First Lienholder Zip:_____ Second First Name:_____. Second Lienholder Name:_____ Second Middle Name:_____. Second Lienholder Address:_____ Second Last Name:_____. Second Lienholder City:_____ Second Address:_____. Second Lienholder State:_____ Second City:_____. Second Lienholder Zip:_____ Second Parish:_____. New or Used:_____ Second State:_____. Previous Title Number:_____ Second Zip:_____. Previous Title State:_____ Cost of vehicle :_____. Within Municipality:_____ Less Trade:_____. Special Tax Area:_____ Rebate:_____. Special Tax District:_____ Tax Value:_____. Dealer Name:_____ Act of Donation:_____.

3 Dealer Collect Tax:_____ Act of Donation Relationship:_____. Dealer License Number:_____ Tax Exempt:_____. Tax Exempt Code:_____. Entry Date:_____.