Fillable Printable Lien Recording Application
Fillable Printable Lien Recording Application
Lien Recording Application
MVR-6
(Rev. 5/17)
Owner 1 ID # ___________________ ________________________________________________________________________________________________________________
Full Legal Name of Owner 1 (First, Middle, Last, Suffix) or Company Name
Owner 2 ID# ___________________ ________________________________________________________________________________________________________________
Full Legal Name of Owner 2 (First, Middle, Last, Suffix) or Company Name
(SEAL)
Signature ____________________________________________________________________
or Typed Name ________________________________________________
My Commission Expires _______________________
Date ______________________________ County _______________________________________________ State _________________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated therein
and in the capacity indicated:
_________________________________________________________________________________(name(s) of principal(s)).
Notary
Notary Printed
All motor vehicle records maintained by the North Carolina Division of Motor Vehicles will remain closed for marketing and solicitation unless the block below is checked.
I (we) would like the personal information contained in this application to be available for disclosure.
APPLICATION MUST BE SIGNED IN INK BY EACH OWNER OR AUTHORIZED REPRESENTATIVE OF FIRMS OR CORPORATIONS.
I, the owner(s) of the vehicle described on this application, certify that the information on the application is true and accurate.
OWNER SIGNATURE ______________________________________________________________________________________________________
Address ___________________________________________________________
Address ___________________________________________________________________
City __________________ State _______ Zip Code ____________________
City ___________________ State __________ Zip Code ________________________
DISCLOSURE SECTION
Date of Lien Maturity Date (MH) Account #
Date of Lien Maturity Date (MH) Account #
Lienholder ID #
Lienholder Name
Lienholder ID #
Lienholder Name
City __________________ State _______ Zip Code ____________________
Address ___________________________________________________________________
City ___________________ State __________ Zip Code ________________________
THIRD LIEN
FOURTH LIEN
BODY STYLE
SERIES MODEL
YEAR
APPLICATION MUST BE FILED WITHIN 20 DAYS OF DATE OF SECURITY AGREEMENT OR LIEN DATE WILL BE PERFECTED BY THE DIVISION TO THE
DATE OF RECEIPT OF APPLICATION.
Address ___________________________________________________________
Date of Lien Maturity Date (MH) Account #
Lienholder ID #
Lienholder Name
Lienholder ID #
Date of Lien Maturity Date (MH) Account #
Lienholder Name
LIEN SECTION
SECOND LIEN
North Carolina Division of Motor Vehicles
LIEN RECORDING APPLICATION
This application must be accompanied with the certificate of title unless it is in the possession of a prior lienholder. The Division, upon receipt of the
application, will procure the title from the prior lienholder for the purpose of recording the new lien and will return the title to the first lienholder
and notify the subsequent lienholder(s) that additional lien(s) has been noted on the certificate of title.
Title #
VEHICLE SECTION
VEHICLE IDENTIFICATION NUMBER
FIRST LIEN
OWNER SECTION
Residence Address (Individual) Business Address(Firm)
Tax County
Mailing Address (if different from above)
City and State
Zip Code
MAKE
