TENNESSEE DEPARTMENT OF REVENUE
TAXPAYER AND VEHICLE SERVICES DIVISION
CERTIFICATION OF SALES UNDER SPECIAL CONDITIONS
Check Type:
Repossession
Garage Keepers Lien Abandoned Vehicle
State of Tennessee
County of Date
(name and address of lienholder)
makes oath in due form of law that the undersigned was the lawful owner and holder of an indebtedness owed by
(name of person owing indebtedness)
of
secured by lien on motor vehicle described as:
Make VIN
Model
Body Type Year Model
Default having been made, the undersigned foreclosed the lien in the manner provided by law and by the terms of the
lien instrument and sold the vehicle described to
of
(name of purchaser)
(address)
for $
, paid
(consideration)
as follows:
The following papers are attached and made a part of the certification:
(A) Repossession - A true copy of the instrument creating the lien and a true copy of the notice of sale (not
required if lien is noted on title).
(B) Garage Keepers Lien - Domestic return receipt. 1 newspaper advertisement and an itemized statement of
charges.
(C) Abandoned Vehicle - Domestic return receipt. If no response, a copy of advertisement and a copy of the
itemized statement of charges.
The undersigned states that all necessary legal provisions were complied with and the purchaser has good title to the
vehicle which is warranted subject to the following lien:
(insert other liens existing, if any)
A transferred certificate of title from the former owner cannot possibly be filed because
(state reason)
Under penalties of perjury, I hereby certify this information is correct to the best of my knowledge.
(name and title of lienholder)
(date)
RV-F1312101 (Rev. 12-04)
(address)
RDA 692
