7/23/2019 Discharge of Lien

1/1

(DO NOT WRITE, MARK, OR STAMP ABOVE THIS LINE)

DATE TITLE NO.

VIN

08TRANSACTION

TYPE

DATE VEHICLE PURCHASED

MOBILE HOMEMAKE 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 BLACKRV-F1310901

TENNESSEE DEPARTMENT OF REVENUE

RDA-692

NOTICE OF DISCHARGE OF LIEN