GEORGIA PRESCRIBED FORM FOR RELEASE OF LIEN ON AUTOMOBILES
I (We) hereby certify that the lien or encumbrance on
Is / was hereby released on .
Full payment of _____________ was made on _________ and hereby fully satisfies the lien. These funds, in cash, have been received by the below mentioned party (parties).
(PRINTED NAME OF LIENHOLDER)
(SIGNATURE OF LIENHOLDER OR AUTHORIZED AGENT)
(PRINTED NAME OF AUTHORIZED AGENT)
Lienholder’s Telephone Number:
WARNING: GEORGIA LAW PROVIDES THAT FALSIFYING INFORMATION ON THIS FORM IS A THIRD – DEGREE FELONY.