HomeMy WebLinkAboutBicycle or Moped Statement of FactHawai'i County is an Equal Opportunity Provider and Employer Created 04/28/09 Updated 2/5/2013 I,THAT SAID MOPED/BICYCLE WAS ACQUIRED FROM:ON OR ABOUT:,20 .Signed this day of 20 Signature Subscribed and sworn to before me this # of pages day of 20 Circuit Notary Public, State of My Commission expires Date Hawai'i County is an Equal Opportunity Provider and Employer THAT THE PREVIOUS OWNER(S)DID TRANSFER HIS/HER INTEREST/OWNERSHIP TO THE SAID MOPED/BICYCLE TO THE UNDERSIGNED;THAT ALL EFFORTS TO LOCATE THE PREVIOUS OWNER(S)TO OBTAIN THE EVIDENCE OF PROOF OF OWNERSHIP HAVE BEEN UNSUCCESSFUL, AND;I AGREE TO INDEMNIFY AND SAVE HARMLESS THE DIRECTOR OF FINANCE,COUNTY OF HAWAI'I AND SUBSEQUENT PURCHASERS OF SAID MOPED/BICYCLE FOR ANY LOSS RESULTING FROM THE ISSUANCE OF A CERTIFICATE OF REGISTRATION COVERING THE SAME AND ON ALL SUBSEQUENT RECORDING OF TRANSFERS OF REGISTRATION.(PLACE NOTARY SEAL HERE)Document Date:STATE OF HAWAII NOTARY CERTIFICATION (PLACE NOTARY SEAL HERE)Notary Name:Notary Signature Document Description:DESCRIBED MOPED/BICYCLE:MAKE AND TYPE:SERIAL NO:STATEMENT OF FACT MOPED/BICYCLE OWNERSHIP CERTIFY THAT I AM THE OWNER OF THE FOLLOWING