LIEN CLEARANCE-MVD

DEPARTMENT OF TRANSPORTATION
MOTOR VEHICLE DIVISION
LIEN CLEARANCE

Date:
I,
^{Name of lien holder, or, if a company, lien holder representative}
that the following lien: Lien date: , lien amount: $

in the name of
^{Borrowers Name}
and appearing on title number:

issued to a
^{Year Make VIN}
has no further interest in, and releases all claim to this vehicle.

Subscribed and sworn to before me this day of

__________________________________ Signature of lien holder, or if a company, lien holder representative _________________________________ ^{Notary Public or MVD Agent} ___________________________________ ^{My commission expires}