Simple Lien Release Form
48-9901 R07/07 www.azdot.gov
Lienholder Name (first, middle, last, suffix) Certificate of Title Number
Borrower Name Lien Amount
Vehicle Identification Number Year Make
I certify that the lien indicated above has been paid in full, that I have no further interest in and release all claims to the vehicle.
Representative Name (if lienholder is an organization) Lienholder Signature
Acknowledged before me this date.
Notary or MVD Agent Signature
Date County State Commission Expires
Simple Lien Release Form PDF
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