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SECTIONS 1 AND 2 SHOULD BE COMPLETED IF ADDING AN …

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTOR VEHICLES 2900 Apalachee Parkway Neil Kirkman Building - Tallahassee, FL 32399-0610 APPLICATION FOR notice OF LIEN / REASSIGNMENT OF LIEN OR notice TO FIRST LIENHOLDER OF SUBSEQUENT LIEN SECTIONS 1 AND 2 SHOULD BE COMPLETED IF ADDING AN ORIGINAL LIEN. MOTOR VEHICLE MOBILE HOME SECTIONS 1 AND 3 SHOULD BE COMPLETED IF REASSIGNING A LIEN. SECTIONS 1, 2 AND 4 SHOULD BE COMPLETED IF ADDING A SUBSEQUENT LIEN. OFF-HWY VEHICLE VESSEL 1) DESCRIPTION OF MOTOR VEHICLE, MOBILE HOME, OFF-HIGHWAY VEHICLE OR VESSEL DESCRIPTION IDENTIFICATION NUMBER VESSEL REGISTRATION NUMBER MAKE/MANUFACTURER YEAR MODEL COLOR TYPE USE CERTIFICATE OF TITLE NUMBER PREVIOUS ISSUE DATE LICENSE PLATE NUMBER 2) notice OF LIEN - LIENHOLDER INFORMATION FEID# Driver License Number and Sex and Date of Birth DMV Account# DATE OF LIEN LIENHOLDER NAME LIENHOLDER S E-MAIL ADDRESS LIENHOLDER ADDRESS CITY

4) NOTICE TO FIRST LIENHOLDER OF SUBSEQUENT LIEN Date _____ To: _____ First Lienholder

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