Fill and Sign the Notice Car 497331229 Form

Notice of Lien by Owner of Auto Repair Garage and Notice of Sale ______________________ (Name of State) Department of Motor Vehicles Pursuant to _______________________ (citation of statute) To: ______________________ (name of owner) , of _______________________________ ________________________________ (street address, city, county, state, zip code) To: ______________________ (name of lienholder) , of ___________________________ ________________________________ (street address, city, county, state, zip code) Please take notice that _____________________ (name of garage owner) , of _____________ ______________________________________________________________ (street address, city, county, state, zip code) , claims a lien on the following described motor vehicle now in the possession of ____________________ (name of garage owner) , under __________________ (citation of statute) : Vehicle Identification Number ____________________________________________ Year: ____________________________________________ Make: ____________________________________________ License Plate Number ____________________________________________ Model: ____________________________________________ Estimated Retail Value Prior to Filing of the Lien: $ ____________________. See Exhibits A, B and C attached. 1 Towing: __________________________ Date towed: __________________________ Amount owed for towing: $___________ Amount owed for repair: $___________ Amount owed for Storage: $___________ Date storage began: ________________ Number of days of storage: ______________ Price per day: $ ___________________ Date original claim was due: _________________ Total amount due: $ ____________________ An additional lien is claimed for storage charges from __________________ (date) to the date of payment or sale, and for charges incurred in enforcing this lien. 1 Number of days and cost per day, including the date of the tow and/or the date the storage charges began with an itemized statement of the claim, the date it was due, and the total amount due are set forth in Exhibit A. If repair costs are claimed, a copy of the invoice (dated) which itemizes the cost of parts and labor is attached as Exhibit B. Authorization to tow, store or repair is attached as Exhibit C. You may redeem this motor vehicle on or before _________________ (date) . ( Note: this date must be at least ____ days after service of this notice). Otherwise, the motor vehicle will be advertised for sale at public auction on ________________ (date) , (which must be at least ____days after the first date of publication): Date of Sale: ______________ Time of Sale: ______________________ Place of Sale: _______________________________________________ (place of sale) By: (e.g., name of auctioneer) _______________________ If you dispute the validity or the amount of this lien, you are entitled to bring a court proceeding under ______________________ (citation of statute) within _______ (number) days of service of this Notice of Lien. The undersigned is the auto repair garage owner with respect to the motor vehicle described in this notice. To the best of my knowledge and belief, the facts stated in this notice are true, the lien claimed on the motor vehicle is valid, and the debt upon which such lien is founded remains unpaid. Witness my signature this __________________ (date) . _________________________________ (Printed Name of Garage Owner) _________________________________ (Signature of Garage Owner)