(DO NOT WRITE, MARK, OR STAMP ABOVE THIS LINE)
DATE
TITLE NO.
VIN
08
TRANSACTION
TYPE
DATE VEHICLE PURCHASED
MOBILE HOME
MAKE
YEAR
LENGTH WIDTH
MODEL
BODY TYPE
LAST NAME
FIRST NAME
MIDDLE INITIAL
LAST NAME
FIRST NAME
MIDDLE INITIAL
STREET ADDRESS
CITY
STATE
ZIP CODE
NAME OF LIENHOLDER
STREET ADDRESS
CITY
STATE
ZIP CODE
DATE OF DISCHARGE
PRINTED NAME (Representative of Lienholder)
SIGNATURE (Representative of Lienholder)
DATE
NOTICE TO LIENHOLDER
Submit this document or a copy of the front of the Certificate of Title reflecting the release of lien within 72 hours of discharge
to the Taxpayer and Vehicle Services Division, 44 Vantage Way, Suite 160, Nashville, Tn 37243-8050.
Second, deliver the Certificate of Title to the person entitled to it with your notation of discharge of Lien indicated. Failure to
comply with the above constitutes a misdemeanor under the provisions of Section 55-3-127 T.C.A.
FORM MUST BE PRINTED OR TYPEWRITTEN IN BLACK
RV-F1310901
TENNESSEE DEPARTMENT OF REVENUE
RDA-692
NOTICE OF DISCHARGE OF LIEN
