Fillable Printable Car Lien Form - California
Fillable Printable Car Lien Form - California
Car Lien Form - California
REG 166 (REV. 1/2015) WWW
LIEN SATISFIED/LEGAL OWNER/TITLE HOLDER RELEASE
Note: If this release accompanies an Application for Duplicate California title (ReG 227), this form must be notarized.
tHIS FoRM CANNot Be USeD to ReLeASe A LIeN oN VeHICLeS 2 MoDeL YeARS AND NeWeR. the legal owner of
record must release interest on the actual Certicate of title. to obtain a replacement title, use an Application for
Duplicate title (ReG 227).
VEHICLE/VESSEL INFORMATION
VEHICLE LICENSE PLATE/CF NUMBER MAKE/BUILDER YEAR MODEL
VEHICLE/VESSEL IDENTIFICATION NUMBER
REGISTERED OWNER INFORMATION — Please print name as it appears on the Title/Registration or Contract.
LAST NAME FIRST NAME MIDDLE NAME
LIENHOLDER/TITLE HOLDER/LEGAL OWNER OF RECORD RELEASE OF OWNERSHIP AND/OR INTEREST
this is to certify that the lien in the name of the Registered owner shown above, against the described vehicle/vessel
has been fully satised and has not been assigned to any other party. the undersigned lienholder (legal owner of
record) certies release of interest in the vehicle/vessel.
NAME OF BANK, FINANCE COMPANY, OR INDIVIDUAL(S) HAVING A LIEN ON THIS VEHICLE
BUSINESS OR RESIDENCE ADDRESS APT./SPACE/STE. NO.
CITY STAT E ZIP CODE
MAILING ADDRESS (IF DIFFERENT FROM ABOVE ADDRESS) APT./SPACE/STE. NO.
CITY STAT E ZIP CODE
SIGNATURE OF LEGAL OWNER (COMPANY NAME AND AUTHORIZED AGENT’S SIGNATURE)
X
DAT E DAYTIME TELEPHONE NUMBER
( )
PRINTED NAME OF AUTHORIZED AGENT TITLE OF AUTHORIZED AGENT SIGNING FOR COMPANY`
NOTARY USE ONLY
A notary public or other officer completing this certicate veries only the identity of the individual who signed the document
to which this certicate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of
On
before me, ,
personally appeared
,
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized capacity(ies), and that
by his/her/their signature(s) on the instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
SIGNATURE
X
(SEAL)
(HERE INSERT NAME AND TITLE OF THE OFFICER)
STATE OF CALIFORNIA
DEPARTMENT OF MOTOR VEHICLES
®
A Public Service Agency
