AMENDING A TITLE OR ADDING A LIEN
[Pages:1]Registry of Motor Vehicles Title Division
P.O. Box 55885 Boston, MA 02205-5885
AMENDING A TITLE OR ADDING A LIEN
Request to (check one):
q Add a Lienholder (Complete Sections A, B, and D) q Correct a Title (Complete Sections A, C, D, and E, if applicable)
$25.00 (Payable by Check or Money Order Only) $25.00 (Payable by Check or Money Order Only)
A Vehicle/Owner Information
Registration Number
Year Make
VIN
Title Number
Owner Name (Last, First, Middle) or Corp/Co Organization Name: Address
Apartment Number
City
State
Zip Code
B
Adding a Lienholder (Original Certificate of Title Must Be Submitted with This Application)
Date of Lien
Lienholder Code
Name of Lienholder
Address
C
Correcting Title (Original Certificate of Title Must Be Submitted with This Application)
Enter information to be corrected:
A notarized affidavit of facts must accompany this form to correct the odometer.
D Signatures
I affirm that all statements herein are true to the best of my knowledge and belief (false statements are punishable by fine, imprisonment, or both).
Signature(s) of Owner(s)
Date
Printed Name(s)
E Mail Title to:
Name Address City
State
Zip Code
Make Check or Money Order Payable to: MassDOT
Do Not Mail Cash
T20065-0111
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