LIENS FOR CHILD SUPPORT CHAPTER 1240-2-5 (Rule 1240-2-5-.16) STATE OF TENNESSEE DEPARTMENT OF HUMAN SERVICES Instructions for the Notice of Lien Purpose of This Form: 42 USC 654(9)(E) requires all IV-D programs to use the Notice of Lien form in interstate cases. IV-D programs may also use the form to impose liens in intrastate cases. This form may also be used for non-IV-D orders by an obligee or his or her private attorney. This form may be used to assert liens on assets discovered through the Financial Institution Data Match process. Please note that the expiration date on this form is the Office of Management and Budget expiration date, not the expiration date of the lien itself. Whose Laws Apply?: All aspects of this lien, including its priority and enforcement, are governed by the law of the State where the property is located. Issue the lien to secure debts for past-due support upon identifying, in another State, nonexempt real or personal property belonging to the obligor. The laws and procedures of the State where the property is located or recorded determine which office or entity in that State is the appropriate one to receive the lien for filing. It is the responsibility of the agency/office or private attorney issuing the lien to file it with the appropriate entity. Release of Lien: To release a previously-filed lien (e.g., upon receipt of full payment, or partial payment with an acceptable agreement to repay remaining balance, etc.,) the original issuing State shall use its existing local release of lien form. A copy of the release of lien should be provided to the obligor. Identify the lien to be released by including the recording information provided by the office or entity that filed the lien (Lien Recorder). The laws and procedures of the State where the lien is filed control the release of the lien. To complete this form: 1. At the top of the form, place the name, address, and fax number of the recorder (i.e., County Auditor, Clerk of Court, DMV, etc.) or asset holder (i.e., Financial Institution, Estate Executor, Trustee, etc.) to which you are sending the lien. NOTE: The procedures of the State where the property is located determine which person or entity in that State is the appropriate one to receive the lien for filing. It is the responsibility of the person/entity/agency submitting the lien to file/serve it correctly. 2. In the “OBLIGOR” field place the obligor's full name, address, date of birth (if known) and social security number (if known). Include known aliases or multiple social security numbers used by the obligor. 3. In the “OBLIGEE” field insert the obligee’s full name. Note that the obligee may be the individual obligee, a public IV-D agency, or a private attorney, person or entity with a proper assignment from the individual obligee. 4. In the “IV-D Case #” field, enter the number/identifier identical to the one submitted on the Federal Case Registry, which is a left-justified 15-character alphanumeric field, allowing all characters except asterisk and backslash, and with all characters in uppercase. 5. In the space following “entered on”, insert the date of entry of the order that is the basis for the lien. 6. In the space following “by”, identify the tribunal that issued the support order that is being used to determine the amount of the lien. A tribunal is a court, administrative agency, or quasi-judicial entity that has the authority to establish, enforce, and modify child support obligations. October, 2005 (Revised) 1 American LegalNet, Inc. www.USCourtForms.com LIENS FOR CHILD SUPPORT CHAPTER 1240-2-5 (Rule 1240-2-5-.16, continued) 7. In the space following “in”, identify the location (State/county) of the tribunal that issued the support order that is being used to determine the amount of the lien. 8. In the space following “tribunal number”, identify the tribunal docket, jacket or file number of the support order that is used to determine the amount of the lien. 9. In the space following “As of”, insert the date of the debt calculation that is used in determining the amount of the lien. 10. In the space following “amount of $”, insert the lien amount (the amount of the past-due support obligation owed when the lien is prepared). Interest may be included in the lien amount if permitted under the law of the State where the lien is filed. 11. In the space following “Specific description of property”, identify any specific property that you want the lien to attach to. Use the legal description of real property and, when the target of the lien is personal property, always provide the most specific identifying information available, including the location of the property, if known. (For example, include the make/model/year/appropriate registration numbers (if known), as opposed to referring to such personal property as “farm equipment”). For Financial Institutions, list the account numbers. 12. Check “A” if the lien is submitted by a IV-D agency and check “B” if the lien is submitted by an obligee or his or her private attorney. 13. Provide the date the lien is signed on the line provided above “date”. 14. If “A” is checked, the appropriate individual should sign the lien on the line above “Authorized Agent”. Type or print the name of the agent signing the lien below their signature. Include the agent’s name, e-mail address (if available) and phone and fax numbers. If “A” is checked, the form does not need to be notarized. Note that, in IV-D cases, the pay-off amount will be available only from the IV-D agency. 15. If “B” is checked, the appropriate individual should sign the lien on the line above the two check boxes and should check the appropriate box. Type or print the name of the person signing the lien below their signature. Include the person’s name, e-mail address (if available) and phone and fax numbers. 16. If “B” is checked, the signature of the party signing the lien must be notarized. 17. In the spaces following “Notary State” and “County”, insert the name of the State and County (if applicable) where the notary is commissioned. 18. Send a copy of the lien to the obligor at his/her last known address. Authority: T.C.A. §§4-5-202, 36-5-901 et seq., and 36-5-912; 42 U.S.C. §§ 652, 654(9)(E), and 666; and United States Department of Health and Human Services Office of Child Support Enforcement Action Transmittal 01-06 (April 4, 2001) and Action Transmittal 05-04 (January 4, 2005). Administrative History: Original rule filed December 18, 2001; effective March 3, 2002. Public necessity rule filed May 20, 2005; effective through November 11, 2005. Amendments filed August 17, 2005; effective October 31, 2005. October, 2005 (Revised) 2 American LegalNet, Inc. www.USCourtForms.com