Transcription of AMENDING A TITLE OR ADDING A LIEN - Massachusetts
1 Registry of Motor VehiclesTitle Box 55885 Boston, MA 02205-5885 AMENDING A TITLE OR ADDING A LIENR equest to ( check one):qAdd a Lienholder (Complete Sections A, B, and D)$ ( payable by check or Money Order Only)qCorrect a TITLE (Complete Sections A, C, D, and E, if applicable )$ ( payable by check or Money Order Only)AVehicle/Owner InformationRegistration NumberYearMakeVINT itle NumberOwner Name (Last, First, Middle) or Corp/Co Organization Name:AddressApartment NumberCityStateZip CodeBAdding a Lienholder (Original Certificate of TITLE Must Be Submitted with This Application)Date of LienLienholder CodeName of LienholderAddressCCorrecting TITLE (Original Certificate of TITLE Must Be Submitted with This Application)Enter information to be corrected:A notarized affidavit of facts must accompany this form to correct the affirm that all statements herein are true to the best of my knowledge and belief (false statements are punishable by fine,imprisonment, or both).
2 Signature(s) of Owner(s)DatePrinted Name(s)EMail TITLE to:NameAddressCityStateZip CodeMake check or Money Order payable to:MassDOTDo Not Mail CashT20065-0111
