Form Mv-21-A - Lien Entry Form Page 2

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Form Number MV-21-A
Revised June 2007
Oklahoma Tax Commission
Motor Vehicle Division
Post Office Box 269061
Oklahoma City, Oklahoma 73126
Lien Entry Form
Debtor Names and Address (Last Name First)
Name(s)
Address
City, State
Zip Code
Secured Party Name
Assignee of Secured Party Name
Address
Address
City, State
City, State
Zip Code
Zip Code
this lien entry form covers the following vehicle
this lien entry form covers the following vehicle
this lien entry form covers the following vehicle
this lien entry form covers the following vehicle
this lien entry form covers the following vehicle
Year
Make
Body Type
Vehicle Identification Number (VIN/HIN)
Date of Security Agreement
Original Oklahoma Title Number
Secured Party / Assignee Signature
Date Executed
Lender must type and print four (4) identical copies of the Lien Entry Form. Type one Lien Entry Form for each vehicle,
boat or outboard motor.
One (1) copy to the Oklahoma Tax Commission, one (1) copy to the motor license agent, one (1) copy to the secured
party or assignee, one (1) copy attached to the title documents to be given to the debtor.
Notice to Debtor: Oklahoma law requires a new owner to title and register his/her vehicle and pay all taxes and fees due
within 30 days of acquiring ownership.

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