Form Mv-21-A - Lien Entry Form - Sample

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Form Number MV-21-A
Revised 10-2016
MVC
O
T
C
KLAHOMA
AX
OMMISSION
M
V
D
OTOR
EHICLE
IVISION
P
O
B
OST
FFICE
OX 269061
O
C
O
KLAHOMA
ITY,
KLAHOMA 73126
L
E
F
IEN
NTRY
ORM
Debtor Names and Address (Last Name First)
Name(s)
Address
City, State, Zip
Secured Party Name
Assignee of Secured Party Name
Address
Address
City, State, Zip
City, State, Zip
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.
F
F
L
O
F
EES (VEHICLES)
EES (BOATS/MOTORS)
IEN
NLY
ILING
Lien Entry Fee
.........$
10.00
Lien Entry Fee
.........$
10.00
Lien Entry Fee
.........$
10.00
Title Fee
.................$
11.00
Title Fee
.................$
2.25
Mail Fee
.................$
1.50
Mail Fee
.................$
1.50
Mail Fee
.................$
1.50
Total
.....................$
11.50
Total
.....................$
22.50
Total
.....................$
13.75
Lien Entry Form-OK
MV-21-A Revised 10-2016
Bankers Systems
*
VMP
,
LEFLZ-OK 10/1/2016
Wolters Kluwer Financial Services
Page 1 of 1

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