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T-4 (Revised 03-2008) Notice to the Department of Revenue Commissioner That the Lien or Security Interest Described Below Has Been Satisfied* If the lien/security interest holder is an ELT (Electronic Lien Title) Participant, a paper lien release form is unacceptable. The lien/security interest can only be released electronically. Name(s) of Owner(s) Vehicle Identification No. (Serial Number) Street Current Title Number State of Issue City, State & Zip Code Vehicle Make and Year Name of Security Interest Holder or Lienholder (as shown on title) Signature of Authorized Representative of Lien or Security Interest Holder Street Printed Name of Authorized Representative of Lien or Security Interest Holder City, State & Zip Code Branch Office (When Applicable) Account Number Telephone Number of Security Interest or Lien Holder including area code *An authorized representative of any branch office may execute this form on behalf of the parent bank/lending institution. IMPORTANT Alterations or erasures void this form. The DOR and County Tag Agents reserve the right to verify the validity of this form prior to acceptance. All fields must be completed including account number (if applicable), lender's telephone number (including area code) and the printed name of the authorized representative of the lender. §40-3-90 of Georgia law provides that a person who, with fraudulent intent, alters or forges an assignment of a certificate of title or an assignment or release of a security interest on a certificate of title or a form the commissioner prescribed shall be guilty of a felony. Print this form! Clear form