Form 12a503 - Application For Specific Lien Release

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12A503
03/2008
APPLICATION FOR SPECIFIC LIEN RELEASE
SEND TO:
Department of Revenue
FOR QUESTIONS OR ASSISTANCE:
Division of Collections
Legal Support Branch
Office: (502) 564-4921, Ext. 4436
P.O. Box 5222
Fax:
(502) 564-7348
Frankfort KY 40602
1.
Name, address and telephone number of person(s) applying for the release.
____________________________________________________________________________
____________________________________________________________________________
2.
Name and COMPLETE address of person to whom the release IS TO BE MAILED.
___________________________________________________________________________
___________________________________________________________________________
3.
Name and address of person(s) the lien(s) filed against.
___________________________________________________________________________
___________________________________________________________________________
4.
How will the debtor be divested of his title in the subject property?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Property is being sold for $______________________ (Attach proposed closing statement if it has been
prepared.)

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