Car (Vehicle) Lien Release Form

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LIEN RELEASE
48-9901 R07/07
Lienholder Name (first, middle, last, suffix)
Certificate of Title Number
Borrower Name
Lien Amount
Vehicle Identification Number
Year
Make
I certify that the lien indicated above has been paid in full, that I have no further interest in and release all claims to the vehicle.
Representative Name (if lienholder is an organization)
Lienholder Signature
Notary or MVD Agent Signature
Acknowledged before me this date.
Date
County
State
Commission Expires

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