Form Sut 4 - Transfer Of Certificate Of Title With Lien
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1SUT 4 (02/20/2015)
TRANSFER OF
CERTIFICATE OF TITLE WITH LIEN
Purpose:
A lienholder uses this form to transfer a certificate of title with a lien.
Instructions:
Submit this form to any DMV Customer Service Center (CSC) with the appropriate fees or mail form and fees
to the Titling Work Center at the above address.
Privacy Act:
This information, including Social Security Number, is requested in accordance with Virginia Code §46.2-623. Any person who refuses to supply
the required information will be denied a Certificate of Title and/or registration. Title and registration records may be disseminated in accordance with
Virginia Code §46.2- 208 through §46.2-214, to business, law enforcement, or authorized government entities.
VEHICLE INFORMATION
YEAR
MAKE
MODEL
TITLE NUMBER
VEHICLE IDENTIFICATION NUMBER (VIN)
CURRENTLY TITLED TO INFORMATION
OWNER NAME (print) - (last)
(first)
(middle)
suffix)
DMV CUSTOMER NUMBER/FEIN/SSN
CO-OWNER NAME (print) - (last)
(first)
(middle)
suffix)
DMV CUSTOMER NUMBER/FEIN/SSN
RETITLE TO INFORMATION
OWNER NAME (print) - (last)
(first)
(middle)
suffix)
DMV CUSTOMER NUMBER/FEIN/SSN
ADDRESS
CITY
STATE
ZIP CODE
CO-OWNER NAME (print) - (last)
(first)
(middle)
suffix)
DMV CUSTOMER NUMBER/FEIN/SSN
ADDRESS
CITY
STATE
ZIP CODE
LIENHOLDER/REPRESENTATIVE INFORMATION
LIENHOLDER NAME (print) - (last)
(first)
(middle)
suffix)
TELEPHONE NUMBER
(
)
ADDRESS
CITY
STATE
ZIP CODE
REPRESENTED BY NAME
TITLE
DATE (mm/dd/yyyy)
LIENHOLDER/REPRESENTATIVE CERTIFICATION
As the lienholder or an authorized representative of the lienholder holding the security interest for the vehicle described above
I certify (check only one):
that the original loan contract for the vehicle remains in force as originally recorded and authorize the addition to,
or removal from the title of the owner(s) named above.
that the individual identified above is the current owner(s) of the vehicle and is recording a new lien on the vehicle for reasons
other than for the purchase of the vehicle.
Note: The above transactions are exempt from motor vehicle sales and use tax (SUT) provided at least one original owner
remains on the newly issued title and motor vehicle sales and use tax (SUT) was paid by the current owner when originally
titling the vehicle (unless the vehicle qualified as tax exempt).
that the purchaser was not on the original loan contract for the vehicle above and authorize the purchaser to assume from
the seller the unpaid obligation for the vehicle in the amount of $
.
Note: This transaction requires that - at the time of titling - motor vehicle sales and use taxes are paid on the unpaid balance
of the loan and any additional monies paid to the seller, or minimum SUT, if greater.
I further certify and affirm that all information presented on this form is true and correct, that any documents I have presented to
DMV are genuine, and that the information included on all supporting documentation is true and accurate. I make this
certification and affirmation under penalty of perjury and I understand that knowingly making a false statement or representation
on this form is a criminal violation.
LIENHOLDER/REPRESENTATIVE NAME (print)
LIENHOLDER/REPRESENTATIVE SIGNATURE
DATE (mm/dd/yyyy)
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