For purchase made in the State of Iowa: This form must be signed and dated by the
buyer and seller prior to the consummation of this sale. The seller for a minimum of
two years should retain this form on file.
Buyer _________________________________ Seller ___________________________________
Name __________________________________Name __________________________________
Address ________________________________Address ________________________________
City ____________ State ____ Zip ___________City ____________ State ____ Zip ___________
Signature _______________________________Signature _______________________________
Date ___________________________________Date ___________________________________
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