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Secretary of State
Vehicle Services Department
Commercial Vehicle
501 S. Second St.
Springfield, IL 62756 Non-Commercial Vehicle
217-782-6306
www.cyberdriveillinois.com
Check if Certificate of Title is lost and no third party is involved in the transaction.
Under penalties of perjury, the undersigned lienholder states that the above requirements have been complied with and the undersigned
lienholder will assume all liability and costs for any litigation that may arise from the issuance of a Certificate of Title.
Notary: Lienholder:
By __________________________________________________
Subscribed and sworn to before me this ___________________ Signature of Lienholder’s Authorized Representative
Printed by authority of the State of Illinois. June 2005 — 10M — VSD 609.3