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Lien Information:
Case Number:
Total Lien Amount:
Lien Completed:	Yes No
Completion Date:
Review Date:
Lien Release Amount:
Lienor:
Lienholder:
Purchaser:
Lien Notes:	$525.00 PAID $225.00

Vehicle Year:
Vehicle Make:
Vehicle Body Type:
Vehicle Title No:
VIN Number:

Owner Name:
Owner Address:
Owner City:
Owner State:
Owner Zip:

Customer Name:
Customer Address:
Customer City:
Customer State:
Customer Zip:

Tow Request:
Tow Date:
Tow Fees:
Storage Rate:
Days/Months in Stoarage:

Newspaper Name:
Notice Date:
County:
Sales Date:
Sales Time:
Sales Location:

Fees:
Title Fees:
Total Fees:
Amount Paid:
Balance Due:

Labor Service:
Storage Charges:
Lien Amount:
Cost of Publication:
Other Fees:
Lienor Retain:

Notes:	TITLE ISSUED 09/02/2025