Missouri Lien Form – Fill Out and Use This PDF

FOR DOR USE ONLY

A $6.00 processing fee must be submitted with each Notice of Lien.

THE ORIGINAL DOCUMENT MUST BE SUBMITTED. It is recommended that you retain a copy for your records.

Form 4809 (Revised 08-2019)

NOTICE OF LIEN

PLEASE PERFECT YOUR LIEN IMMEDIATELY!

IMPORTANT: Liens must be filed and/or received with the Department within 30 days of the loan date (perfected) for the lienholder to be protected from the debtor filing for bankruptcy relief.

A $6.00 processing fee must be submitted with each Notice of Lien.

OWNER INFORMATION AND UNIT DESCRIPTION — Complete all applicable blocks.

FIRST LIEN — Complete the FIRST LIENHOLDER INFORMATION section, if applicable.

SECOND LIEN — Complete the FIRST and SECOND LIENHOLDER INFORMATION sections, if applicable.

First Lienholder Authorization — This block must be signed by the first lienholder when adding a second lien.

Checks may be accepted as payment. Make checks payable to: Missouri Department of Revenue. The check must be pre-printed with the check writer’s name, address, bank code, and account number. It must also include the following information regarding the check writer:

1.Driver license or non-driver license number;

2.Date of birth; and

3.Daytime phone number.

Other restrictions may apply. NOTE: The Missouri Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds.

The lienholder will receive a receipt as proof the lien has been perfected.

Submit the completed Notice of Lien (Form 4809) to your local license office or by mail to the following address:

MOTOR VEHICLE BUREAU

301 WEST HIGH STREET

PO BOX 3355

JEFFERSON CITY MO 65105-3355

LIEN RELEASE

OWNER INFORMATION AND UNIT DESCRIPTION SECTIONS — Complete all applicable blocks.

FIRST AND SECOND LIENHOLDER SECTIONS — Leave blank.

LIEN RELEASE SECTION — Enter the lienholder’s name as shown on title, the date of release, printed name of the lienholder’s agent, and signature of lienholder’s agent.

NOTARIZATION — The notary information is required to be completed to release the lien.

NOTE: License Office notary service - $2.00

FRAUDULENT LIEN RELEASE — ANY PERSON WHO KNOWINGLY AND INTENTIONALLY SUBMITS A SEPARATE DOCUMENT RELEASING A LIEN OF ANOTHER WITHOUT THE AUTHORITY TO DO SO SHALL BE GUILTY OF A CLASS D FELONY. (301.640, RSMo)

Form 4809 (08-2019)