Form Mvt 21-1 - Request For Assignment And Transfer Of Lien - 1995
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1
2MVT 21-1 Rev 3/95
Request For Assignment
and Transfer of Lien
Alabama Department of Revenue
Motor Vehicle Division • Title Section
TITLE NUMBER
DEPARTMENT USE ONLY
P. O. Box 327640, Montgomery, AL 36132-7640
TYPE OR PRINT ONLY
NOTE: THE OUTSTANDING TITLE MUST ACCOMPANY THIS FORM, WITHOUT LIEN RELEASED ON FACE OF TITLE, AS A SUPPORTING DOCUMENT
V
VEHICLE IDENTIFICATION NUMBER
TRANS CODE
YEAR MODEL
MAKE
MODEL
BODY TYPE PREVIOUS ALABAMA TITLE NUMBER
E
I
04
H
N
I
F
C
CYLS
NEW
USED
DEMO
DATE OF PURCHASE
NUMBER LIENS
COLOR
CURRENT ODOMETER READING
DEPARTMENT USE ONLY
O
L
E
THE FOLLOWING SECTIONS MUST BE FILLED OUT COMPLETELY
NAME (LAST NAME MUST BE LISTED FIRST)
FELONY OFFENSE FOR FALSE ADDRESS
DEPARTMENT USE ONLY
O
W
N
MAILING ADDRESS
E
R
CITY
STATE
ZIP
I
N
F
ALABAMA OPERATOR (LESSEE) NAME AND/OR RESIDENT ADDRESS IF DIFFERENT FROM ABOVE FELONY OFFENSE FOR FALSE ADDRESS
O
R
M
ADDRESS
COUNTY
A
T
I
CITY
STATE
ZIP
O
N
FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD
FIRST LIENHOLDER NAME
LIEN DATE
ADDRESS
L
CITY
STATE
ZIP
I
E
N
FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD
SECOND LIENHOLDER NAME
LIEN DATE
I
N
F
ADDRESS
O
LOCATOR NUMBER
R
M
CITY
STATE
ZIP
A
REJECT TO:
T
I
FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD
O
THIRD LIENHOLDER NAME
LIEN DATE
REASONS:
N
ADDRESS
EXAMINER NUMBER:
CITY
STATE
ZIP
ENCL:
BOTH ASSIGNOR AND ASSIGNEE MUST COMPLETE AND SIGN
ASSIGNOR
ASSIGNEE
The lien shown in the name of the undersigned assignor on Certificate of Title
The undersigned assignee confirms transfer of the lien as
No. ___________________ issued on ______ day of _________________ 19_____
described by the assignor and hereby requests that a new
to___________________________________________________________________
Certificate of Title be issued subject to all liens listed on
whose address is: Street or RFD ________________________________________
this application.
City ______________________________ State ________ Zip Code ____________
Name (Assignee): ___________________________________
is hereby assigned to __________________________________________________
Address: ___________________________________________
whose address is: Street or RFD ________________________________________
City: _______________________________________________
City ______________________________ State ________ Zip Code ____________
State: ____________________ Zip Code ________________
this ___________ day of __________________________ 19______
Date of Lien: _______________________ (Same as on Title)
__________________________________________________________
___________________________________________________
Lienholder (Assignor)
Lienholder (Assignee)
__________________________________________________________
___________________________________________________
Authorized Signature
Authorized Signature
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