Kentucky Application for Specific Lien Release

Application for Specific Lien Release
Microsoft Word - Application for Specific Lien Release03-28-08.DOC
12A503
03/2008

APPLICATION FOR SPECIFIC LIEN RELEASE

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 release.
____________________________________________________________________________
____________________________________________________________________________

2.

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

3.

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

4.

How will the debtor be divested of his title in the subject property?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Property is being sold for $______________________ (Attach proposed closing statement if it has been
prepared.)

5.

Legal description (including Book and Page Number of the Deed) and street address or location of
real property; 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 RELEASE.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

6.

Attach accurate copies of ONLY THOSE LIEN(S) which you are requesting to have released. 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.

7.

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:

____________________

____________________

____________________

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

8.

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

9.

Itemize all anticipated actual costs, commissions, and expenses of the transfer or sale of the
property. (Additional space is provided on the next page.)
If a lien release is to cover real estate, a copy of the closing statement should be attached and
this section may be omitted.

(1)
Paid to:

(2)

(3)

____________________

____________________

____________________

____________________

____________________

____________________

____________________

____________________

____________________

Reason:

____________________

____________________

____________________

Amount:

____________________

____________________

____________________

(4)
Paid to:

(5)

(6)

____________________

___________________

___________________

____________________

___________________

___________________

____________________

___________________

___________________

Reason:

____________________

___________________

___________________

Amount:

____________________

___________________

___________________

10.

Furnish information to establish the value of the property for which the specific lien release 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. In addition:
A.

If public sale (auction) already held – give the date and place the sale was held, the amount
for which the property was sold, and the name and address of the purchaser(s).

B. If public sale (auction) to be held – give the proposed date and place of the sale, and include a
statement that the Department of Revenue will be paid in its proper priority from the proceeds
of the sale.

11.

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 _________________________________________________________.