RELEASE OF LIEN BY LEGAL OWNER SFN 2876 (Rev. 02-2014)

RELEASE OF LIEN BY LEGAL OWNER
MOTOR VEHICLE DIVISION
ND DEPARTMENT OF TRANSPORTATION
608 E BOULEVARD AVE
BISMARCK ND 58505-0780
Telephone (701) 328-2725
Fax (701) 328-1487
Website: www.dot.nd.gov
North Dakota Department of Transportation, Motor Vehicle Division
SFN 2876 (Rev. 02-2014)
Registered Owner(s)
Address
Year
Make
City
State
Model
Style
Vehicle Identification Number
Zip Code
Title Number
The undersigned, LIEN HOLDER of the motor vehicle described herein, does hereby state that the lien and encumbrance
described was released and discharged, and the certificate of title has been delivered to the REGISTERED OWNER of said
vehicle on the date of release.
X
FIRM NAME
SIGNATURE
DATE
ACKNOWLEDGEMENT
STATE OF
)
COUNTY OF
)
ss
On this
day of
, 20
,
personally appeared before me,
a notary public, and is known to me to be the person named in and who executed the foregoing instrument and
acknowledged that they executed the same.
(Notary Seal)
NOTARY PUBLIC (Type or Print Name)
NOTARY PUBLIC (Signature)
My Commission Expires