Division of Motor Vehicles Release of Lien West Virginia Department of Transportation

DMV-12-A-TR
REV 09/11
West Virginia Department of Transportation
Division of Motor Vehicles
Titles and Registrations
PO Box 17110 • Charleston, WV 25317
1-800-642-9066 • www.dmv.wv.gov
Release of Lien
___________________________________________________________________________________ hereby releases a
NAME OF LIEN HOLDER
________________________________________________________________________________________________ to
CONDITIONAL SALE CONTRACT, RESERVATION OF TITLE, CHATTEL MORTGAGE, DEED OF TRUST, OR OTHER CHARACTER OF LIEN
_________________________________________ created to secure payment in the sum of ______________________
HOLDER OF LIEN, DEBTER, OR REGISTERED OWNER
TOTAL AMOUNT SPELLED OUT
dollars ($_____________ ) dated the _______ day of _____________________ 20_____, recorded on West Virginia
NUMERAL AMOUNT
DAY
MONTH
YEAR
Certificate of Title number _________________________ issued by the WVDMV the date of __________________ to
TITLE NUMBER
MONTH
DAY
YEAR
______________________________________ ___________________________________________________________
NAME OF REGISTERED OWNER
STREET ADDRESS OF REGISTERED OWNER
_______________________________________ as the registered owner of the motor vehicle in said Certificate of Title
CITY
STATE
ZIP CODE
described as being a ________ ____________ _______________________________________________________.
YEAR
MAKE
VIN/SERIAL NUMBER
In witness whereof said ________________________________________________________________________ has
NAME OF CORPORATION
caused its corporate name to be signed hereto by its __________________________________________________ duly
TITLE OF OFFICER
authorized this ______ day of ___________________, 20_____.
DAY
MONTH
YEAR
___________________________________________,
TYPED OR PRINTED NAME OF CORPORATION
a corporation by ____________________________________________, _________________________________.
SIGNATURE OF OFFICER
TITLE OF OFFICER
Acknowledged before the subscriber, by _________________________________________________ who signed
NAME OF OFFICER
the name of ___________________________________________________________________________, a corporation,
NAME OF CORPORATION
thereto this _____ day of ____________________ 20_____.
DAY
MONTH
YEAR
(X)
_________________________________________________________________________
NOTARY PUBLIC SIGNATURE
My Commission expires on ___________/____________/____________________.