Application For Motor Vehicle Temporary Lien
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Application For Motor Vehicle Temporary Lien Form. This is a Tennessee form and can be use in Miscellaneous Secretary Of State.
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Tags: Application For Motor Vehicle Temporary Lien, SS-4258, Tennessee Secretary Of State, Miscellaneous
For Office Use Only
APPLICATION FOR MOTOR
VEHICLE TEMPORARY
LIEN
Motor Vehicle Temporary Lien Program
312 Eighth Avenue North
6th Floor, William R. Snodgrass Tower
Nashville, TN 37243
Control Number:
Return Acknowledgement Notice To:
Name
Address
,
City
State
Motor Vehicle Identification Number:
Zip Code
(Filing Office Use Only)
Lienholder Information:
Business
or
Name
First
Middle
Last
Address
Instrument Creating Lien Executed On:
/
MM
/
DD
,
City
Year
Debtors / Lessee Information:
State
Zip Code
Payment Method
Business
or
Name
Check
Voucher
First
Middle
Number
Number
Last
Address
,
City
State
Zip Code
In order to record a motor vehicle temporary lien, this form MUST be completed (typed or printed in ink) in its entirety and
returned with a notarized copy of the instrument creating the lien and the required fee of $10.00 (ten dollars) to:
Tennessee Department of State
Motor Vehicle Temporary Lien Program
312 Eighth Avenue North
6th Floor, William R. Snodgrass Tower
Nashville, Tennessee 37243-0306
(615)741-0529
SS-4258
RDA 836-1
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