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Get and Sign Notice of Lien Form Ny 2015
Borrower, if any
OWNER INFORMATION
Owner’s Last Name
First
M.I.
Owner’s Last Name
First
M.I.
Street Address (including Apt. No.)
City
State
o Check here if this is a new address
Zip Code
NOTE: Lien will be recorded only if the name(s) listed as the owner(s) is EXACTLY the same as the owner(s) recorded, or to be recorded, on
the Certificate of Title. If a Certificate of Title has not been issued to this borrower, print the name as it appears on the driver license.
OWNER’S STATEMENT: I...
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