STATEMENT

      MID-FLORIDA LIEN AND TILTE SERVICE LLC  

3001 Aloma Avenue

Suite 227-A

Winter Park, Florida 32792

(407) 657-7995

[Date.Today]

[lienor.company_name]

[lienor.address]

[lienor.city], [lienor.state] [lienor.zip]

[lienor.home_phone]

INVOICE NO. [lien.case_no]                         AMOUNT

FOR VEHICLE:  [lien.vehicle_year], [lien.vehicle_make] 

VIN NO. [lien.vehicle_vin]

LIEN FEE                                  [lien.fees]

PAID                                      [lien.paid_amount]

TOTAL AMOUNT DUE                          [lien.balance_due]

THANK YOU,

MID-FLORIDA LIEN AND TITLE SERVICE, LLC.