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Fillable Printable Temporary Lien Recording Application

Fillable Printable Temporary Lien Recording Application

Temporary Lien Recording Application

Temporary Lien Recording Application

MVR-6T
(Rev. 10/17)
North CarolinaDivisionofMotor Vehicles
TEMPORARY LIEN RECORDING APPLICATION
VEHICLE SECTION
YEAR
MAKE
BODYSTYLE
SERIES MODEL
VEHICLE IDENTIFICATION NUMBER
FUEL TYPE
OWNER SECTION
Owner 1ID#
Owner2ID#
Residence Address (Individual) Business Address (Firm)
Full Legal Name ofOwner 1(First, Middle, Last, Suffix) or Company Name
Full Legal Name ofOwner 2 (First, Middle, Last, Suffix) orCompany Name
City and State
Zip Code
TaxCounty
Mail Address
(if
different from above)
LIEN SECTION DISCLOSURE SECTION
FIRST LIEN
Account #
Maturity Date (MH)
Lienholder Name
All motor vehicle records maintained by the North
Carolina Division ofMotor Vehicles will remain closed
for
marketing and solicitation unless the block
below
is
checked.
Address
I (We) would like the personal information contained in
this application to
be
availablefor disclosure.
CityState Zip Code
APPLICATION MUST BESIGNEDININK BYEACH OWNERORAUTHORIZED REPRESENTATIVEOFFIRMS ORCORPORATIONS.
I (we), the owner(s) ofthe vehicle described on this application certify that the informationonthe application istrue and correct.
OWNER'SSIGNATURE
Date CountyState
________________________
Icertify that the following person(s) personally appeared before methis day, each acknowledging tomethat heorshe voluntarily signed the foregoing document for the
purpose stated therein and inthe capacity indicated:
(name(s) of principal(s)).
Notary
Signature
Notary Printed
orTyped Name
New
(SEAL)MyCommission Expires
DEALER SECTION
Used
Purchase Date
Previous NCTitle Number
I
certify
that the above vehicle has been soldto the person(s) listed above.
I
further
certify that the title for this vehicle
is
currently unavailable and this form is being filed torecord the lien declared above. I understand that the notation of
this lien
will expire
60
days after the creation ofthe security
interest,
oruponperfection ofthe security interest with a
title
application and supporting documents.
Signature
ofDealer orAgent:
Dealer#
Printed Firm
Name
Date County State
I
certify that the following person(s) personally appeared before methis day, each acknowledging tomethat heorshe voluntarily signed the foregoing document for the
purpose stated therein and inthe capacity indicated:
(name(s) of principal(s)).
Notary
Signature
Notary Printed
orTypedName
(SEAL)
MyCommission Expires
Date of Lien
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