Form 12A503 "Application for Specific Lien Release" - Kentucky

What Is Form 12A503?

This is a legal form that was released by the Kentucky Department of Revenue - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2008;
  • The latest edition provided by the Kentucky Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 12A503 by clicking the link below or browse more documents and templates provided by the Kentucky Department of Revenue.

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Download Form 12A503 "Application for Specific Lien Release" - Kentucky

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12A503
03/2008
APPLICATION FOR SPECIFIC LIEN RELEASE
SEND TO:
Department of Revenue
FOR QUESTIONS OR ASSISTANCE:
Division of Collections
Legal Support Branch
Office: (502) 564-4921, Ext. 4436
P.O. Box 5222
Fax:
(502) 564-7348
Frankfort KY 40602
1.
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.)
12A503
03/2008
APPLICATION FOR SPECIFIC LIEN RELEASE
SEND TO:
Department of Revenue
FOR QUESTIONS OR ASSISTANCE:
Division of Collections
Legal Support Branch
Office: (502) 564-4921, Ext. 4436
P.O. Box 5222
Fax:
(502) 564-7348
Frankfort KY 40602
1.
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)
(2)
(3)
Name &
____________________
____________________
____________________
Address:
____________________
____________________
____________________
____________________
____________________
____________________
Description:
____________________
____________________
____________________
Date Recorded:
____________________
____________________
____________________
*Amount Due:
____________________
____________________
____________________
*Attach a written statement for each creditor holding a superior lien attesting to the balance due.
(4)
(5)
(6)
Name &
____________________
___________________
___________________
Address:
____________________
___________________
___________________
____________________
___________________
___________________
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)
(2)
(3)
Paid to:
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Reason:
____________________
____________________
____________________
Amount:
____________________
____________________
____________________
(4)
(5)
(6)
Paid to:
____________________
___________________
___________________
____________________
___________________
___________________
____________________
___________________
___________________
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 _________________________________________________________.
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