TRANSFER OF CERTIFICATE OF TITLE WITH LIEN Purpose: Instructions: A lienholder uses this form to transfer a certificate of title with a lien. SUT 4 (05/05/2011) Submit completed form to a DMV Customer Service Center or Titling Work Center at the above address. VEHICLE INFORMATION YEAR MAKE TITLE NUMBER VEHICLE IDENTIFICATION NUMBER (VIN) CURRENTLY TITLED TO INFORMATION CURRENTLY TITLED TO NAME (last) (first) (mi) (suffix) SOCIAL SECURITY/FEDERAL EMPLOYER ID NUMBER (FEIN) RETITLE TO INFORMATION RETITLE TO NAME (last) (first) (mi) (suffix) ADDRESS SOCIAL SECURITY/FEDERAL EMPLOYER ID NUMBER (FEIN) Check one box as applicable. NEW TRANSFEREE OTHER (specify) ADDITIONAL TRANSFEREE NAME DELETED LIENHOLDER/REPRESENTATIVE INFORMATION LIENHOLDER NAME TELEPHONE NUMBER ( ADDRESS ) REPRESENTED BY NAME(print) TITLE DATE (mm/dd/yyyy) LIENHOLDER/REPRESENTATIVE CERTIFICATION I, as lienholder or representative of the lienholder, certify that: lien is to remain in force as originally recorded on the original contract. _____________________________ has assumed unpaid obligation of _____________________________ at the time of transfer and was not on the original contract. _____________________________ is recording a new lien for a personal reason, not for the purchase of this vehicle. I/We further certify and affirm that all information presented in this form is true and correct, that any documents I/we have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I/We make this certification and affirmation under penalty of perjury and I/we understand that knowingly making a false statement or representation on this form is a criminal violation. REPRESENTATIVE SIGNATURE DATE (mm/dd/yyyy) LIENHOLDER SIGNATURE DATE (mm/dd/yyyy) American LegalNet, Inc. www.FormsWorkFlow.com