I Title # YEAR MAKE BODY STYLE SERIES MODEL VEHICLE ...
MVR-6 (Rev. 5/17)
North Carolina Division of Motor Vehicles
LIEN RECORDING APPLICATION
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. 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.
VEHICLE SECTION
YEAR
IMAKE
I I BODY STYLE SERIES MODEL
VEHICLE IDENTIFICATION NUMBER
OWNER SECTION
ITitle #
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
Residence Address (Individual) Business Address(Firm)
City and State Mailing Address (if different from above)
Zip Code
ITax County
Date of Lien Lienholder ID #
FIRST LIEN
Maturity Date (MH)
ILienholder Name
LIEN SECTION
Account #
Date of Lien Lienholder ID #
SECOND LIEN
Maturity Date (MH)
ILienholder Name
Account #
Address ___________________________________________________________
Address ___________________________________________________________________
City __________________
State _______ Zip Code ____________________
THIRD LIEN
City ___________________ State __________ Zip Code ________________________
FOURTH LIEN
Date of Lien Lienholder ID #
Maturity Date (MH) Lienholder Name
Account #
Date of Lien Lienholder ID #
Maturity Date (MH) Lienholder Name
Account #
Address ___________________________________________________________
Address ___________________________________________________________________
City __________________
State _______ Zip Code ____________________ City ___________________ State __________ Zip Code ________________________
DISCLOSURE SECTION
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 ______________________________________________________________________________________________________
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 Signature ____________________________________________________________________
Notary Printed or Typed Name ________________________________________________
(SEAL)
My Commission Expires _______________________
................
................
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