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1320-FM-DCNR0046:Rev. 10/09

COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
SNOWMOBILE/ATV UNIT
AFFIDAVIT OF OWNERSHIP
(Bill of Sale/Gift Form)
I/WE___________________________________________________________________
NAME OF PURCHASER/RECIPIENT
____________________________________________________________________________________________________________
STREET ADDRESS
PHONE

________________________________________________________________________
CITY

STATE

ZIP CODE

COUNTY

PURCHASED FROM _____________________________________________________
NAME OF SELLER/DONOR
____________________________________________________________________________________________________________
STREET ADDRESS
PHONE
____________________________________________________________________________________________________________
CITY
STATE
ZIP CODE
COUNTY
THE ATV/SNOWMOBILE LISTED BELOW:
MODEL

YEAR

MAKE OF VEHICLE

Purchase Price: $________________________
(List Purchase Price or Gift)