HSMV 82139: Florida Application for Notice of Lien

Complete sections 1 and 2 if adding an original lien.

Complete sections 1 and 3 if reassigning a lien.

Complete sections 1, 2 and 4 if adding a subsequent lien.

In section 1, the description of the motor vehicle, mobile home, off-highway vehicle or vessel is Identification Number, Vessel Registration Number, Make/Manufacturer, Year, Model, Wt.-Lgth.-Bhp, Color, Type, Use, Certificate of Title Number, Previous Issue Date and License Plate Number.

Section 2 is the Notice of Lien - Lienholder Information: FEID#, Driver License Number and Sex and Date of Birth, DMV Account#.

Enter the Date of Lien, Lienholder Name, Lienholder's E-mail Address, Lienholder Address, City, State and Zip Code.

Electronic title and lien participant (Electronic title only).

If the lienholder authorizes the department to send title to the owner, check the box and countersign (does not apply to vessels).

One of the following boxes must be checked.

A security agreement, retain title contract, conditional bill of sale, chattel mortgage or other similar instrument was executed prior to the filing of this notice of lien.

This notice of lien is being filed before a security agreement, retain title contract, conditional bill of sale, chattel mortgage or other similar instrument is being executed.

Under penalties of perjury, the registered owner and co-owner declare that they have read the document and that the facts stated in it are true.

Sign as Registered Owner and, if there is a Registered Co-Owner, sign as Registered Co-Owner. Enter the Print Name, Street Address, City, State and Zip Code of each, and the Date.

Section 3 is the Application for Reassignment of Lien.

The undersigned represents that they are the assignee of that certain first or second lien dated the day of (Month/Year), covering the motor vehicle, mobile home, off-highway vehicle or vessel described in section one of this form.

The undersigned requests that the Florida Certificate of Title, which was issued on (Month/Day/Year), be re-issued to show such lien as now being held by the undersigned applicant, and represents that on this date there is a balance as principal still due and unpaid.

Under penalties of perjury, the Name of Assignee (New Lienholder) declares that they have read the document and that the facts stated in it are true; add the Signature of Lienholder's Representative, Title, Address, City, State and Zip Code.

Under penalties of perjury, the Name of Assignor (Lienholder currently shown on Title) declares that they have read the document and that the facts stated in it are true, with the Signature of Lienholder's Representative.

Section 4 is the Notice to First Lienholder of Subsequent Lien.

Enter the Date, the First Lienholder in the To line, and the First Lienholder Address, City and State, and Zip Code.

Enter the Title Number on which the first lienholder is recorded, covering the motor vehicle, mobile home, off-highway vehicle or vessel, in the office of the Division of Motorist Services in Tallahassee, Florida.

Florida statutes require the first lienholder to submit the certificate of title to the Division of Motorist Services within ten (10) days after receipt of this notice, unless the DMV database reflects an electronic title.

Enter the Name of Subsequent Lienholder, Lienholders E-mail Address, Address, City, State and Zip Code of the additional lien placed on the motor vehicle, vessel, off-highway vehicle or mobile home. To the first lienholder, please forward the Certificate of Title with this request attached, if applicable, to the Division of Motorist Services, at Tallahassee, Florida, for the purpose of recording the subsequent lien thereon.

When the subsequent lien is recorded, the Division of Motorist Services will mail a Certificate of Title, if applicable, to the first lienholder.

Under penalties of perjury, I declare that I have read the document and that the facts stated in it are true.

Sign as Owner and, if there is a Co-Owner, sign as Co-Owner; enter the Name, Print or Type. When using section 4 of this form, prepare in duplicate and send a copy of this form by registered or certified mail with the returned receipt requested to the first lienholder, as shown on the DMS database record.

Submit the original copy of the form to a county tax collector's office with the return receipt signed by the first lienholder and the lien recording fee provided by section 328.14(6), Florida Statutes, for vessels, by section 319.32(1) and (2) (a), Florida Statutes, for motor vehicles and mobile homes and sections 317.0006(5) (a), & 317.0007(1), Florida Statutes, for off-highway vehicles.

If the first lienholder fails, neglects or refuses to forward the certificate of title to the department within 10 days from the date of the owner's request, the department, on the written request of the subsequent lienholder or an assignee thereof, shall make written demand for the return of such certificate of title for the notation of the second or subsequent lien or encumbrance.

Submit this form to your local tax collector office.