A
D
R
LABAMA
EPARTMENT OF
EVENUE
TO RECORD A LIEN ONLY
PPLIC TION
WITH AN OUTSTANDING
M
V
D
– T
S
MVT 20-1
OTOR
EHICLE
IVISION
ITLE
ECTION
ALABAMA TITLE* NOT TO
BE USED ON A TRANSFER
R 1/12
P. O. Box 327640 • Montgomery, AL 36132-7640 • titles@revenue.alabama.gov
OF OWNERSHIP OR BY
Application For Certificate of Title
DESIGNATED AGENT.
*See exemptions on
TYP
OR PRINT
to Record or Transfer a Lien
reverse of form.
ONLY
THIS FORM MAY BE DUPLICATED OR ADDITIONAL COPIES MAY BE OBTAINED FROM THE DEPARTMENT WEB SITE AT
VEHICLE INFORMATION
*
TRANS
YEAR
MAKE
MODEL
VEHICLE IDENTIFICATION NUMBER
CODE
MODEL
04
CYLS
NEW
USED
DATE OF PURCHASE
NUMBER
COLOR
ODOMETER READING
CURRENT ALABAMA TITLE NO.
LIENS
OWNER INFORMATION
NAME (LAST, FIRST, MIDDLE)
FELONY OFFENSE FOR FALSE ADDRESS
FOR OFFICE USE ONLY
MAILING ADDRESS
CITY
STATE
ZIP
NAME
ALABAMA OPERATOR (LESSEE) NAME AND / OR RESIDENT ADDRESS IF DIFFERENT FROM ABOVE
RESIDENT ADDRESS
FELONY OFFENSE FOR FALSE ADDRESS
CITY
STATE
ZIP
LIEN INFORMATION
NAME FIRST LIENHOLDER
FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD
MAILING ADDRESS
LIEN DATE (M/D/Y)
LOCATOR NO.:
CITY
STATE
ZIP
REJECT TO:
NAME SECOND LIENHOLDER
FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD
REASONS:
MAILING ADDRESS
LIEN DATE (M/D/Y)
EXAMINER NO.:
CITY
STATE
ZIP
ENCL.:
SIGN COMPLETED FORM ONLY, FELONY OFFENSE FOR FALSE STATEMENTS
A
C
I, THE UNDERSIGNED, CERTIFY THAT THE VEHICLE DESCRIBED ABOVE IS OWNED BY ME AND I HERE-
THE UNDERSIGNED ASSIGNOR AND ASSIGNEE CONFIRM THAT THE LIEN HELD BY THE ASSIGNOR HAS
BY MAKE APPLICATION FOR A CERTIFICATE OF TITLE FOR SAID MOTOR VEHICLE AND THIS VEHICLE
BEEN TRANSFERRED TO THE ASSIGNEE. BOTH PARTIES HEREBY REQUEST THAT A NEW CERTIFICATE
WILL NOT BE THE SUBJECT OF LIEN PRIOR TO RECEIPT OF TITLE UNLESS INDICATED ABOVE. I FURTHER
OF TITLE BE ISSUED SUBJECT TO THE LIENS LISTED ON THIS APPLICATION.
CERTIFY THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWL-
EDGE AND BELIEF.
ASSIGNOR
OWNER
LIENHOLDER
SIGNATURE(S)
NAME:
AUTHORIZED
SIGNATURE:
(PERSONALLY SIGNED BY EACH OWNER (IN INK) OR AUTHORIZED REPRESENTATIVE OF FIRM)
B
I HEREBY CERTIFY THAT ALL INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT
DATE:
TO THE BEST OF MY KNOWLEDGE AND BELIEF.
ASSIGNEE
LIENHOLDER
NAME:
LIENHOLDER
NAME:
AUTHORIZED
SIGNATURE:
AUTHORIZED
SIGNATURE:
DATE:
DATE:
NOTE: LIEN DATE FOR TRANSFERRED LIEN(S) MUST REMAIN THE SAME. ALSO, NO CHANGES ARE PERMIT-
NOTICE OF SECURITY INTEREST
TED IN THE OWNER INFORMATION (OTHER THAN ADDRESS CHANGES).
SECTIONS A AND B OR SECTION C MUST BE COMPLETED
THIS FORM MAY BE DUPLICATED
*All VINs for 1981 and subsequent year model
Submit $15.00 Application Processing Fee (non-refundable)
vehicles that conform to federal anti-theft stan-
FEE – $15.00
in certified funds payable to Alabama Department of
dards are required to have 17 digits/characters.
Revenue. Do not send personal checks or cash.
1
2
