MVR-6T
(Rev. 10/17)
North Carolina Division of Motor Vehicles
TEMPORARY LIEN RECORDING APPLICATION
VEHICLE SECTION
YEAR
MAKE
BODYSTYLE
SERIES MODEL
VEHICLE IDENTIFICATION NUMBER
FUEL TYPE
OWNER SECTION
Owner 1 ID#
Owner 2 ID#
Residence Address (Individual) Business Address (Firm)
Full Legal Name of Owner 1 (First, Middle, Last, Suffix) or Company Name
Full Legal Name of Owner 2 (First, Middle, Last, Suffix) or Company Name
City and State
Zip Code
Tax County
Mail Address
(if
different from above)
LIEN SECTION DISCLOSURE SECTION
FIRST LIEN
Account #
Maturity Date (MH)
Lienholder Name
All motor vehicle records maintained by the North
Carolina Division of Motor Vehicles will remain closed
for
marketing and solicitation unless the block
below
is
checked.
Address
I (We) would like the personal information contained in
this application to
be
available for disclosure.
City State Zip Code
APPLICATION MUST BE SIGNED IN INK BY EACH OWNER OR AUTHORIZED REPRESENTATIVE OF FIRMS OR CORPORATIONS.
I (we), the owner(s) of the vehicle described on this application certify that the information on the application is true and correct.
OWNER'S SIGNATURE
Date County State
________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the
purpose stated therein and in the capacity indicated:
(name(s) of principal(s)).
Notary
Notary Printed
or Typed Name
New
(SEAL) My Commission Expires
DEALER SECTION
Used
Purchase Date
Previous NC Title Number
I
certify
that the above vehicle has been sold to the person(s) listed above.
I
further
certify that the title for this vehicle
is
currently unavailable and this form is being filed to record the lien declared above. I understand that the notation of
this lien
will expire
60
days after the creation of the security
interest,
or upon perfection of the security interest with a
title
application and supporting documents.
Signature
of Dealer or Agent:
Dealer#
Printed Firm
Name
Date County State
I
certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the
purpose stated therein and in the capacity indicated:
(name(s) of principal(s)).
Notary Printed
or Typed Name
(SEAL)
My Commission Expires
Date of Lien
