TENNESSEE DEPARTMENT OF REVENUE

Application for Noting of Lien, Duplicate Title, or Multipurpose Use

NEW OR CURRENT TITLE NUMBER TRANSACTION REGISTRATION ONLY NUMBER
CODE*

OWNER INFORMATION *LEGAL STATUS: 1 (AND) 2 (OR) ENTER NAME CODE IN BOX 1 (SAME) 2 (DIFFERENT) 3 (MULTIPLE LAST NAMES) 4 (COMPANY) 5 (OVER 25 CHARACTERS) MAO ILU
LAST NAME FIRST NAME MIDDLE INITIAL LAST NAME FIRST NAME MIDDLE INITIAL

ADDRESS 1 (MAILING) ADDRESS 2 (PHYSICAL) CITY STATE ZIP CODE

CITY STATE ZIP CODE ADDITIONAL OWNER

CNTY OF RESIDENCE/PRINCIPAL BUS OR INCORP LOCATION PURCHASE DATE TELEPHONE # PLACARD/HEARING IMPAIRED CLS/YR *INSURANCE POLICY #
*LEASED *SERVICE OPTIONS

VEHICLE INFORMATION
VIN MAKE MODEL YEAR BODY TITLE BRAND - translation CODE TYPE OF FUEL - translation CODE

SURRENDERED TITLE # STATE PREVIOUS STATES TITLED VEHICLE USE VEHICLE TYPE CURRENT MILEAGE ODOMETER ACTUAL (0) NOT ACTUAL (3) CODE
INDICATOR OVER 10 YRS/16,000 LBS. (1)
(List one) IN EXCESS OF MECHANICAL LIMITS (9)

COLOR CODE (enter appropriate code)* MOBILE HOME # AXLES GROSS VEHICLE WEIGHT *VEHICLE TRADE-IN DESCRIPTION COMPANY VEHICLE #
UPPER LOWER LGTH WDTH

PLATE INFORMATION *(required for Title and Registration and Registration Only Transactions)
PLATE #(1) CLASSCODE/ISSUE YR(1)(3) VALIDATION #(1) COUNTY STICKER #(1) CITY STICKER #(1)(2) *PLATE # (TRADE IN) (2) CLASS CODE/ISSUE YR (2) EXPIRATION DATE (1) (2) (3)

TDR STICKER # (4) TEMP OPERATOR PERMIT # (3) # OF SEATS (5) ZONE COUNTY NAME (6) USDOT/REGISTRANT #(7) MOTOR CARRIER #(8)

LIEN INFORMATION (if lien present)

FIRST LIENHOLDER LIEN DATE

STREET CITY STATE ZIP CODE

SECOND LIENHOLDER LIEN DATE

STREET CITY STATE ZIP CODE

LESSEE/REGISTRANT INFORMATION (OWNER OF PLATE) LEGAL STATUS NAME CODE MAO ILU
NAME NAME

ADDRESS CITY STATE ZIP CODE

VEHICLE COST/TAX INFORMATION *(required for Title and Registation Transactions)

SALE PRICE TRADE IN ALLOWANCE WARRANTY AMOUNT TAXABLE AMOUNT SALES TAX PAID *TAX EXEMPTION REASON/SALES TAX#

DEALER NAME DEALER ADDRESS DEALER #

*Required for Duplicate Title - T.C.A. 55-3-115 (submit illegible or altered Certificate of Title)

LOST STOLEN MUTILATED RETURNED DUE TO NON DELIVERY ALTERED ILLEGIBLE

Under penalties of perjury, I hereby certify all information provided is true and correct to the best of my knowledge, and acknowledge that it is not the responsibility of the Vehicle Services Division or its assignees to determine the accuracy
of the information provided by me or on my behalf.
SIGNATURE OF CERTIFIER/OWNER POWER OF ATTORNEY/AUTHORIZED SIGNATURE (IF APPLICABLE) DATE
X
INVOICE NUMBER COUNTY NAME CO NUMBER DATE OF APPLICATION BY AUTHORITY OF REGISTRAR OF MOTOR VEHICLES (COUNTY CLERK)

OFFICE USE ONLY

REGISTRATION FEE ELECTRIC VEHICLE FEE CREDIT LEASE FEE TRANS FEE CLERK FEE ISSUANCE FEE LIEN FEE TITLE FEE TOTAL TAX COLLECTED

COMPUTATION OF SALES OR USE TAX LOCAL RATE ADDITIONAL TAX COLLECTED IN STATE OF COUNTY WHEEL TAX CITY WHEEL TAX INS FEE
SALES TAX USE TAX
*SERVICE OPT FEE ORGAN DONOR POSTAGE VER ID/RESIDENCY VERIFICATION VIN PLATE FEE *TOTAL FEES COLLECTED

RV-F1315201 (Rev. 04-20)

 INSTRUCTIONS FOR NOTING OF LIEN
Please read instructions carefully before completing this application. Failure to provide all information may result in
your application being returned.

Complete the above application. Supporting documents must include a copy of the lien instrument, owner's
Tennessee Certificate of Title* (if no existing lien) and corresponding payment. Please remit to your local county
clerk's office. For a listing of county clerk contact information and locations, please visit http://www.tn.gov/revenue/
title-and-registration/county-clerks-locations.

Fee Information: Fee for Noting of Lien is $11.00 per new lien plus $14.00 title fee (please contact county
additional county fees).

Note: The requirements for noting a second lien are the same as above except the Certificate of Title is not necessary.
Name and address of Lienholder must be shown in the space indicated "Second Lienholder."

A Conditional Sales Contract is not acceptable as a Lien Instrument unless previously recorded and merely being
assigned.

INSTRUCTIONS FOR FOR DUPLICATE TITLE

Please read instructions carefully before completing this application. Failure to provide all information may result in
your application being returned.

Fee Information: The cost for a Duplicate Title is $14.00 (Additional county fees may apply).

If a lien exists in the records of the Vehicle Services Division, a duplicate title can only be issued to the lienholder.
When a lien has been discharged, the owner may apply for a duplicate title, which will be mailed to the owner’s
address as shown on the application. If the owner has proof of the discharge, it should accompany the owner’s
request for a duplicate title.

This completed application should be signed and submitted to the County Clerk with supporting documentation, when
applicable. Please indicate the reason a duplicate is being requested in the "Required for Duplicate Title" section of
this application.