Free 01014 Redesign.FH11 - Indiana

REQUEST FOR OUT OF STATE TITLE TO PERFECT LIEN
State Form 1014 (R3 / 10-05) BUREAU OF MOTOR VEHICLES

We respectfully request the original title to the motor vehicle/watercraft described below on which you hold lien. Indiana law requires that such title be surrendered before an Indiana title can be issued or the vehicle/watercraft registered. The new title will be sent to you by the Indiana Bureau of Motor Vehicles to hold until the lien is satisfied. Do not release your lien; we will record your lien on the Indiana title. If, for any reason, you cannot release the title, please notify us at once.
PLEASE MAIL REQUESTED TITLE TO

Indiana Auto License Branch (name and number) Street address City

State

ZIP code

Reason Name of owner Present street address City Former street address City

REQUEST FOR MOTOR VEHICLE / WATERCRAFT TITLE

State

ZIP code

State

ZIP code

Make

Year

VEHICLE / WATERCRAFT DESCRIPTION
Date of purchase (month, day, year)

Vehicle identification number

Date (month, day, year) Street address City

In favor of

LIEN

State

ZIP code

If you have any questions, please contact _________________________________ at (Phone #) ________________________.
FOR BRANCH USE

Date request sent (month, day, year) Customer daytime phone number

Completed by

(

)

VIN Check Completed?
INSURANCE INFORMATION

Yes

No

Company name Policy number