Form Mv-900.1 - Notice Of Lien - Charge Account Customer

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MV-900.1 (11/15)
NOTICE OF LIEN - CHARGE ACCOUNT CUSTOMER
All information (other than signature) must be typed. Use caution when entering Vehicle, Hull or Manufactured Home ID number.
Liens will not be recorded if information is illegible, incorrect or incomplete.
Your DMV Charge Account Number: _____________________
VEHICLE/BOAT/MANUFACTURED HOME INFORMATION
Identification
This is a:
o
o
o
o
Vehicle
Boat
Trailer
Manufactured home
Number
Year
Make
Body Type/
Registration/Plate No.
Hull
of Borrower, if any
OWNER INFORMATION
Owner’s Last Name
First
M.I.
Owner’s Last Name
First
M.I.
Street Address (including Apt. No.)
o
City
State
Zip Code
Check here if this is a new address
NOTE: Lien will be recorded only if the name(s) listed as the owner(s) is EXACTLY the same as the owner(s) recorded, or to be recorded, on
the Certificate of Title. If a Certificate of Title has not been issued to this borrower, print the name as it appears on the driver license.
OWNER’S STATEMENT: I understand that the lienholder will send this notice to the DEPARTMENT OF MOTOR VEHICLES. If a title was
previously issued in my name for this vehicle, boat, trailer or manufactured home, I gave it to the lienholder to be sent to DMV with this notice.
I understand that a new Certificate of Title, showing the lienholder’s name, will be mailed to me.
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_______________________________
________________________________ Date _______________
OWNER(S): SIGN HERE
(Must be an original signature. If a POA is used,
(Must be an original signature. If a POA is used,
a copy of the POA must be attached.)
a copy of the POA must be attached.)
If signing for a corporation, print your name and title:
______________________________________ ________________________________
(Name)
(Title)
Lien Filing Code (assigned by DMV:
LIEN INFORMATION
enter only if a code has been assigned to you or your company)
Lienholder’s Name
Lienholder’s Name (continued)
Street Address
City
State
Zip Code
This notice authorizes the Department of Motor Vehicles to disclose (or otherwise make available) information about the lienholder obtained by
the department in connection with this record.
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Date of Security Agreement_________________________
________________________________________________________________________
(Lienholder’s Signature—Must be an original signature or a facsimile stamp)
o
o
Has a NY Certificate of Title been issued to this borrower?
YES
NO
IF YES, ATTACH TITLE.
LIENHOLDER: Mail this form and the owner’s title (if issued) to:
TITLE BUREAU, NEW YORK STATE DEPARTMENT OF MOTOR VEHICLES PO BOX 2604, ALBANY, NY 12220-0604
You can verify online if a lien was recorded or if a title certificate was issued.
Go to the Lien/Title Certificate Status page at the DMV web site: /titlestat/default.html
MV-900.1 (11/15)
DO NOT DETACH THIS RECEIPT
YOUR DMV CHARGE ACCOUNT NUMBER: _____________________
PLEASE TYPE LIEN FILING CODE, AND NAME AND ADDRESS OF THE ACCOUNT TO BE CHARGED:
Lien Filing Code:
Vehicle Identification
Number (VIN):
Account Name
Street Address (including Apt. No.)
City or Town
State
Zip Code
reset/clear

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