State Form 23104 "Mechanic's Lien Bill of Sale" - Indiana

Mechanic's Lien Bill of Sale

State Form 23104, Mechanic's Lien Bill of Sale, is the document you fill out when selling a vehicle in Indiana as a mechanic's lien holder. This form is an important part of the sales documentation required for a buyer in order to obtain a Certificate of Title.

The form was issued by the Indiana Bureau of Motor Vehicles (BMV). It was last revised on July 1, 2016. You can download the fillable version of Indiana State Form 23037 through the link below.

Complete the form using your computer or in blue or black ink only. You must complete this document in its entirety and deliver it to the buyer upon sale. An incomplete document will not be accepted by the Indiana BMV.

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How to Do a Mechanic's Lien in Indiana?

Any person who performed labor, furnished materials, or did repairs on a vehicle, as well as those who provided storage services and did not receive satisfaction of the reasonable charges for the performed services within 30 days after the vehicle was left in the custody of that person, can file a mechanic's lien against this vehicle. According to state laws, filing a mechanic's lien in Indiana, the seller must adhere to the following rules:

  1. Vehicle must be advertised for sale at a public auction;
  2. Owner of the vehicle must be notified about the mechanic's lien holder's intention to sell the car;
  3. Mechanic's lien holder cannot sell the vehicle earlier than 15 days after the advertisement appeared in a newspaper or after the owner was notified about the sale, whichever comes later.

The seller must enclose the certificate or affidavit of the publication and proof of delivery of the notification sent via certified mail to the owner of the vehicle, as well as a copy of this notification to the Mechanic's Lien Bill of Sale.

The form includes four sections:

  • Section 1. Seller Information. Enter your name, full address, and Social Security or Federal Identification number. The latter is optional;
  • Section 2. Owner/Vehicle Information. Provide the name and last known address of the owner of the vehicle, as well as a full description of the car (the VIN, year, make, model, type, color, and license plate number);
  • Section 3. Lien Information. Indicate information pertinent to the lien and the sale process: the type of lien, charges and costs against the described vehicle, date it was left in custody, date you advertised the car for sale and the name of the newspaper containing the advertisement, name and license number of the auction company or auctioneer who sold the car, auctioneer's signature, your signature, printed name, and date you signed the form;
  • Section 4. Purchaser Information. This part requires the buyer's name, address, date of sale, purchase price, buyer's signature, and date signed.

State Form 23104 Related Forms

Use this form if you are the holder of the mechanic's lien only. If you want to sell your own car, complete State Form 44237, Bill of Sale for this purpose. Fill out the same document if you need to sell a watercraft in Indiana.

The other forms related to the State Form 23104 include:

  1. State Form 50635, Affidavit of Sale or Disposal, Abandoned Manufactured Home;
  2. State Form 205, Application for Certificate of Title for a Vehicle;
  3. State Form 55714, Motor Driven Cycle (MDC) Affidavit, Affirmation of Ownership and/or Cubic Centimeters (CC);
  4. State Form 43230, Odometer Disclosure Statement;
  5. State Form 43753, Trailer Ownership Affidavit;
  6. State Form 39530, Physical Inspection of a Vehicle or Watercraft;
  7. State Form 12907, Application for Special Identification Number Motor Vehicle or Watercraft;
  8. State Form 37964, Affidavit.

These forms are official documents provided by the Indiana BMV as a part of the documentation you may need when selling or buying a vehicle and watercraft within the state.

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Download State Form 23104 "Mechanic's Lien Bill of Sale" - Indiana

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BUREAU OF MOTOR VEHICLES
MECHANIC’S LIEN BILL OF SALE
100 North Senate Avenue, N411
State Form 23104 (R6 / 7-16)
Indianapolis, IN 46204
INDIANA BUREAU OF MOTOR VEHICLES
* This agency is requesting disclosure of your Social Security number / Federal Identification number for accuracy of records in accordance with IC 4-1-8;
disclosure is voluntary and you will not be penalized for refusal.
INSTRUCTIONS:
1. Complete in blue or black ink, or print form.
2. Seller must complete this form in its entirety and deliver to the purchaser of a vehicle in accordance with Indiana Code 9-22 in
order for purchaser to obtain a certificate of title.
3. A certificate or affidavit of publication from the newspaper verifying the vehicle was advertised for sale at public auction must be
submitted with this form. The vehicle may not be sold before fifteen (15) days after the date of the advertisement.
4. Proof of the mechanic’s lien notice to owner and lienholder (if applicable) must be provided with this form.
SECTION 1 - SELLER INFORMATION
Person who holds the mechanic’s lien
Name of Seller (first, middle, last, or company name)
*Social Security Number or Federal Identification Number (optional)
Address of Seller’s Residence (number and street)
City
State
ZIP Code
SECTION 2 – OWNER / VEHICLE INFORMATION
Name of Owner(s) (first, middle, last, or company name)
Last Known Address of Owner’s Residence (number and street)
City
State
ZIP Code
Vehicle
Vehicle
Vehicle
License Plate
Vehicle Identification Number
Vehicle Make
Vehicle Color
Year
Model
Type
Number
SECTION 3 - LIEN INFORMATION
The charges and costs against the vehicle are as follows:
Eligible Lien Type: (required)
Repair Work –
Materials
Storage
Total
Labor, Materials, Storage, or Repair Work Lien (Mechanic’s lien)
Labor
$
$
$
$
Abandoned Vehicle Lien
Date Vehicle Left in Seller’s Custody (mm/dd/yyyy)
Newspaper Name
Advertisement Date (mm/dd/yyyy))
Auction Company/Auctioneer Name
Signature
Auction Company/Auctioneer License Number
I swear and affirm under penalties for perjury that I am the Seller of the Vehicle identified on this form, and I affirm that the
following is true and correct:
1.
The Owner requested that the Vehicle be repaired or stored and/or the Vehicle has been abandoned.
2.
The Vehicle was left in the Seller’s custody and the Owner failed or refused to claim the Vehicle within thirty (30) days.
3.
The Owner was notified by certified mail that the Vehicle would be sold at public auction to satisfy the above charges.
The Vehicle was advertised for sale at a public auction.
4.
Signature of Seller
Printed Name
Date Signed (mm/dd/yyyy)
SECTION 4 - PURCHASER INFORMATION
Name of Purchaser(s) (first, middle, last, or company name)
* Social Security Number or Federal Identification Number (optional)
Address of Purchaser’s Residence (number and street)
City
State
ZIP Code
Date of Sale (mm/dd/yyyy))
Purchase Price
$
I swear and affirm under the penalties for perjury that the information I have entered on this form is correct. I understand that
making a false statement may constitute the crime of perjury.
Signature of Purchaser
Printed Name
Date Signed (mm/dd/yyyy)
Reset Form
BUREAU OF MOTOR VEHICLES
MECHANIC’S LIEN BILL OF SALE
100 North Senate Avenue, N411
State Form 23104 (R6 / 7-16)
Indianapolis, IN 46204
INDIANA BUREAU OF MOTOR VEHICLES
* This agency is requesting disclosure of your Social Security number / Federal Identification number for accuracy of records in accordance with IC 4-1-8;
disclosure is voluntary and you will not be penalized for refusal.
INSTRUCTIONS:
1. Complete in blue or black ink, or print form.
2. Seller must complete this form in its entirety and deliver to the purchaser of a vehicle in accordance with Indiana Code 9-22 in
order for purchaser to obtain a certificate of title.
3. A certificate or affidavit of publication from the newspaper verifying the vehicle was advertised for sale at public auction must be
submitted with this form. The vehicle may not be sold before fifteen (15) days after the date of the advertisement.
4. Proof of the mechanic’s lien notice to owner and lienholder (if applicable) must be provided with this form.
SECTION 1 - SELLER INFORMATION
Person who holds the mechanic’s lien
Name of Seller (first, middle, last, or company name)
*Social Security Number or Federal Identification Number (optional)
Address of Seller’s Residence (number and street)
City
State
ZIP Code
SECTION 2 – OWNER / VEHICLE INFORMATION
Name of Owner(s) (first, middle, last, or company name)
Last Known Address of Owner’s Residence (number and street)
City
State
ZIP Code
Vehicle
Vehicle
Vehicle
License Plate
Vehicle Identification Number
Vehicle Make
Vehicle Color
Year
Model
Type
Number
SECTION 3 - LIEN INFORMATION
The charges and costs against the vehicle are as follows:
Eligible Lien Type: (required)
Repair Work –
Materials
Storage
Total
Labor, Materials, Storage, or Repair Work Lien (Mechanic’s lien)
Labor
$
$
$
$
Abandoned Vehicle Lien
Date Vehicle Left in Seller’s Custody (mm/dd/yyyy)
Newspaper Name
Advertisement Date (mm/dd/yyyy))
Auction Company/Auctioneer Name
Signature
Auction Company/Auctioneer License Number
I swear and affirm under penalties for perjury that I am the Seller of the Vehicle identified on this form, and I affirm that the
following is true and correct:
1.
The Owner requested that the Vehicle be repaired or stored and/or the Vehicle has been abandoned.
2.
The Vehicle was left in the Seller’s custody and the Owner failed or refused to claim the Vehicle within thirty (30) days.
3.
The Owner was notified by certified mail that the Vehicle would be sold at public auction to satisfy the above charges.
The Vehicle was advertised for sale at a public auction.
4.
Signature of Seller
Printed Name
Date Signed (mm/dd/yyyy)
SECTION 4 - PURCHASER INFORMATION
Name of Purchaser(s) (first, middle, last, or company name)
* Social Security Number or Federal Identification Number (optional)
Address of Purchaser’s Residence (number and street)
City
State
ZIP Code
Date of Sale (mm/dd/yyyy))
Purchase Price
$
I swear and affirm under the penalties for perjury that the information I have entered on this form is correct. I understand that
making a false statement may constitute the crime of perjury.
Signature of Purchaser
Printed Name
Date Signed (mm/dd/yyyy)