New York State Department of Motor Vehicles NOTICE OF LIEN AND SALE Under Sections 184 and 201 of the Lien Law of the State of New York To: To: Owner Name Address Lienholder Name Address o Please check this box if there are additional lienholders or interested parties, and attach a list of their names and addresses. For titled vehicles and boats, you may obtain lien and title information on the MV-15 form and mailing it to the Department of Motor Vehicles, Certified Document Center, 6 Empire State Plaza, Albany, New York 12228, with a fee of $10 per record. Lienholder information about vehicles that are not subject to NYS titling laws is available from the New York State Department of State at www.dos.state.ny.us or 99 Washington Avenue, 6th Floor, Albany, N.Y. 12231. Please take notice that ____________________________________________________________________________________________ hereby claims a lien (GARAGEMAN’S BUSINESS NAME AND ADDRESS) on the following motor vehicle or boat now in the garageman’s possession, under Section 184 of the Lien Law of the State of New York: Year Make Plate Model Estimated Retail Value Prior to Filing of the Lien Vehicle Identification Number or Hull ID Number $ The nature of the lien (towing and/or daily storage charges listing the number of days and cost per day, including the date of the tow and/or the date the storage charges began) with an itemized statement of the claim, the date it was due, and the total amount due is listed below. If repair costs are claimed, a copy of the invoice (dated) which itemizes the cost of parts and labor is attached. Authorization to tow, store or repair is also attached. REPAIR MISCELLANEOUS TOWING STORAGE Date storage began ______________ Amount owed $ __________ Number of days ________________ ______________________________ Date Towed ______________ ______________________________ Price per day ______________________________ Amount owed $____________ DATE ORIGINAL CLAIM WAS DUE: $ ________________ Amount owed $ ________________ TOTAL AMOUNT DUE $: An additional lien is claimed for storage charges from ____________________________________________ to the date of payment or sale, and for charges (DATE) incurred in enforcing this lien. You may redeem this motor vehicle or boat on or before ________________________________ (date must be at least 10 days AFTER service of this notice). (DATE) Otherwise, the motor vehicle or boat will be advertised for sale at public auction on (date must be at least 15 days AFTER the first date of publication): DATE: ______________________________ PLACE: ____________________________________________________________________________ TIME: ______________________________ BY: ____________________________________________________________________________ (AUCTIONEER) If you dispute the validity or the amount of this lien, you are entitled to bring a court proceeding under Section 201-a of the Lien Law within 10 days of service of this Notice of Lien. I am the garageman with respect to the motor vehicle or boat described in this notice. To the best of my knowledge and belief, the facts stated in this notice are true, the lien claimed on said motor vehicle or boat is valid, and the debt upon which such lien is founded remains unpaid. - (GARAGEMAN’S SIGNATURE - Please sign name in full) DATE (GARAGEMAN’S NAME - Print) (GARAGEMAN’S ADDRESS - Print) If signing for a corporation, please print your full name, address and title. IMPORTANT: False statements are punishable under Section 392 of the Vehicle and Traffic Law and Section 210.45 of the Penal Law. MV-901A (5/11) www.dmv.ny.gov American LegalNet, Inc. www.FormsWorkFlow.com