Get GA T-4 2013-2024

PRINT CLEAR Form T-4 Rev. 12-2013 NOTICE OF SATISFACTION OF SECURITY INTEREST OR LIEN HOLDER S AFFIDAVIT Instructions This Affidavit should be executed by the person who holds a security interest or lien on the motor vehicle described below pursuant to Article 3 of Chapter 3 in Title 40. Except for signatures type or print legibly in black or blue ink or complete electronically and print* Note This form is not permitted for use by any participant in the Electronic Lien on Title ELT for any security interest or lien which has been recorded electronically. Personally appearing before the undersigned officer duly authorized by law to administer oaths comes of Printed Full Legal Name of Sole Proprietor/Partner or Executive Officer and Driver s License Number Legal Business Name of Security Interest or Lien Holder as listed on Certificate of Title Business address including city state and zip code Owner s names as it appears on Certificate of Title Residence address including city state and zip code Vehicle Year Make Vehicle Identification Number Model Body Style State of Title Records Title number Account number I understand that pursuant to the Motor Vehicles Certificate of Title Act the State Revenue Commissioner has the authority to investigate issues surrounding the titling and registration of motor vehicles and may refuse to issue a certificate of title if there are reasonable grounds to believe that the application contains a false statement or the applicant fails to furnish required information or documents or any additional information the commissioner reasonably requires. I understand that the Department may have information as to the vehicle s title history the security interest holder s or the owner s address or some other information that is relevant to the Act s requirements which lien holder does not have. I understand that based upon this information the Department has the discretion to reject the application for title. Yes Notary Public Acknowledgement I am over the age of majority and give this affidavit on the basis of my personal knowledge of facts and circumstances surrounding the security interest or lien related to the motor vehicle listed Sole Proprietor/Partner or Executive Officer Signature Date Notary Public residence address including City State and Zip Code Sworn to and subscribed before me this of Day Month Year Date Notary Commission Expires This form must be legibly completed and attached to the application for Certificate of Title. Except for signatures type or print legibly in black or blue ink or complete electronically and print* Note This form is not permitted for use by any participant in the Electronic Lien on Title ELT for any security interest or lien which has been recorded electronically. Personally appearing before the undersigned officer duly authorized by law to administer oaths comes of Printed Full Legal Name of Sole Proprietor/Partner or Executive Officer and Driver s License Number Legal Business Name of Security Interest or Lien Holder as listed on Certificate of Title Business address including city state and zip code Owner s names as it appears on Certificate of Title Residence address including city state and zip code Vehicle Year Make Vehicle Identification Number Model Body Style State of Title Records Title number Account number I understand that pursuant to the Motor Vehicles Certificate of Title Act the State Revenue Commissioner has the authority to investigate issues surrounding the titling and registration of motor vehicles and may refuse to issue a certificate of title if there are reasonable grounds to believe that the application contains a false statement or the applicant fails to furnish required information or documents or any additional information the commissioner reasonably requires. .