Titles and Registrations. PO Box 17110 • Charleston, WV 25317. 1-800-642- 9066 • www.dmv.wv.gov. DMV-12-A-TR. REV 09/11. West Virginia Department of T...
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DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES ... o One proof of residential address in the name of the ... may present an Address Verification Letter from the
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Although a titling trust may be used either with a lease ... registered owner and/or lienholder on the certificates of title
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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 ___________/____________/____________________.
