Kentucky Application for Certificate of Subordination of Kentucky Tax Lien

Application for Certificate of Subordination of Kentucky Tax Lien
Microsoft Word - Application for Cetificate of Subordination03-28-08.doc
12A502
03/2008

APPLICATION FOR CERTIFICATE OF SUBORDINATION
OF KENTUCKY DEPARTMENT OF REVENUE LIEN

SEND TO:

1.

Department of Revenue
Division of Collections
Legal Support Branch
P.O. Box 5222
Frankfort KY 40602

FOR QUESTIONS OR ASSISTANCE:

Office: (502) 564-4921, Ext. 4436
Fax:
(502) 564-7348

Name, address and telephone number of person(s) applying for the certificate of subordination of lien.
____________________________________________________________________________
____________________________________________________________________________

2.

Name and COMPLETE address of person to whom the certificate IS TO BE MAILED.
___________________________________________________________________________
___________________________________________________________________________

3.

Name and address of person(s) the lien(s) filed against.
___________________________________________________________________________
___________________________________________________________________________

4.

Debtor's Social Security Number and Business Tax Numbers?
SSN:

____________________________________________________________________

Withholding Tax No.:________________________________________________________
Sales & Use Tax No.:________________________________________________________
Corporation Income: ________________________________________________________
Other: _____________________________________________________________________

5.

Name and address of financial institution from which you are obtaining loan? Please attach a
letter from the institution stating the exact amount of the loan; also, indicate if this is a business
loan or other type of loan. Your application will not be processed without this information.
__________________________________________________________________________________
__________________________________________________________________________________
AMOUNT OF LOAN: $__________________________ (Attach proposed Closing Statement if it
has been prepared.)

6.

Legal description (including Book and Page Number of the Deed) and street address or location
of real property to be used as collateral; complete description and identifying numbers of
personal property to be used as collateral. Attach additional sheets if necessary. If attachments
are used, UNDERLINE the EXACT description of the property AS IT IS TO APPEAR ON THE
CERTIFICATE.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

7.

Attach accurate copies of ONLY THOSE LIEN(S) which you are requesting to be subordinated. IF
SAID LIENS ARE NOT ATTACHED, THIS APPLICATION CANNOT BE PROCESSED AND WILL BE
HELD WITH NO ACTION TAKEN UNTIL THE REQUIRED LIEN(S) ARE SUBMITTED.

8.

List all recorded lien(s) and mortgages which are superior to Kentucky Department of Revenue
lien(s). (Additional space is provided on the next page.)
(1)

Name &
Address:

(2)

(3)

____________________

____________________

____________________

____________________

____________________

____________________

____________________

____________________

____________________

Description:

____________________

____________________

____________________

Date Recorded:

____________________

____________________

____________________

*Amount Due:

____________________

____________________

____________________

(4)
Name &
Address:

(5)

(6)

____________________

___________________

___________________

____________________

___________________

___________________

____________________

___________________

___________________

Description:

____________________

___________________

___________________

Date Recorded:

____________________

___________________

___________________

*Amount Due:

____________________

___________________

___________________

*Attach a written statement for each creditor holding a superior lien attesting to the balance due.

9.

If a tax lien has been filed by the Internal Revenue Service, a copy of that lien, as well as the
certificate of subordination or letter of commitment given by the IRS MUST accompany this
request.

10.

Furnish information to establish the value of the property for which the certificate of
subordination is to apply by submitting certified copies of TWO (2) professional appraisals.
Include an estimate of the fair market value of the property which will remain subject to the lien.

11.

Reason for Request.

12.

Please list any additional properties you own and attach copies of the property deed(s).

"I DECLARE, UNDER PENALTIES OF PERJURY, THAT THIS APPLICATION HAS BEEN EXAMINED BY
ME AND, TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS TRUE, CORRECT AND COMPLETE."
______________________________________
APPLICANT
Subscribed and sworn to before me this the _______ day of ________________, 200___.

______________________________________
NOTARY PUBLIC
My commission expires _________________________________________________________.