Form Ss-4258 - Application For Motor Vehicle Temporary Lien
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1For Office Use Only
APPLICATION FOR MOTOR
VEHICLE TEMPORARY
LIEN
Motor Vehicle Temporary Lien Program
312 Eighth Avenue North
6 th Floor, William R. Snodgrass Tower
Nashville, TN 37243
Return Acknowledgement Notice To:
Control Number:
Name
Address
,
City
State
Zip Code
(Filing Office Use Only)
Motor Vehicle Identification Number:
Lienholder Information:
Business
or
Name
First
Middle
Last
Address
Instrument Creating Lien Executed On:
/
/
,
City
State
Zip Code
MM
DD
Year
Debtors / Lessee Information:
Payment Method
Business
Check
Number
or
Name
First
Middle
Last
Voucher
Number
Address
,
City
State
Zip Code
In order to record a motor vehicle temporary lien, this form MUST be completed (typed or printed in ink) in its entirety and
00
returned with a notarized copy of the instrument creating the lien and the required fee of $10.
(ten dollars) to:
Tennessee Department of State
Motor Vehicle Temporary Lien Program
312 Eighth Avenue North
th
6
Floor, William R. Snodgrass Tower
Nashville, Tennessee 37243-0306
(615)741-0529
SS-4258
RDA 836-1
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Parent category: Legal