Bicycle/Moped Notice of Transfer

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DEPARTMENT OF FINANCE VEHICLE REGISTRATION&LICENSING DIVISION COUNTY OF HAWAII-STATE OF HAWAII BICYCLE/MOPED NOTICE OF TRANSFER SELLER REQUIRED TO SUBMIT THIS FORM TO THE DEPARTMENT WITHIN 10 DAYS OF SALE,FINE$100.00 You are required by law to immediately notify the Department of Finance,Vehicle Registration&Licensing Division,when you sell or otherwise dispose of a bicycle/moped. This form is provided for use in reporting the sale or transfer to the Division and does not constitute application for transfer of ownership. TO REMOVE YOUR NAME FROM THE DIVISION'S RECORD,THE NEW BUYER MUST APPLY FOR TRANSFER USING THE ENDORSED REGISTRATION RECEIVED FROM YOU. When the information contained in this form is recorded by the Department of Finance,Vehicle Registration&Licensing Division(see warning below),liability after the date of sale becomes the responsibility of the subsequent purchaser(s). Notification must be made on this official form within TEN DAYS from the date of transfer or sale. Penalty for failure to comply is a fine up to$100. Deliver property endorsed Registration to new owner or buyer. MAKE PROMPT NOTIFICATION, PROTECT YOURSELF FROM ANY POSSIBLE LIABILITY. WARNING: ANY INCOMPLETE, INACCURATE OR ILLEGIBLE INFORMATION WILL PREVENT THE RECORDING OF THE INFORMATION CONTAINED IN THE NOTICE AND RESULT IN NON-COMPLIANCE WITH THE LAW. MAIL COMPLETED NOTICE OF TRANSFER TO: Department of Finance,Vehicle Registration&Licensing Division 101 Pauahi Street,Suite 5,Hilo,HI 96720 DECAL NO. MAKE SERIAL NO. DATE OF TRANSFER YOU ARE HEREBY NOTIFIED THAT I (WE), THE UNDERSIGNED OWNER(S) OF THE BICYCLE/MOPED DESCRIBED ABOVE,SOLD,OR TRANSFERRED MY(OUR)INTEREST IN SAID BICYCLE/MOPED TO A NEW OWNER. PRINT NAME OF NEW OWNER PRINT ADDRESS OF NEW OWNER SIGNATURE OF TRANSFEROR(S)OR SELLER(S) ADDRESS OF TRANSFEROR(S)OR SELLER(S) Hawai'i County is an Equal Opportunity Provider and Employer