Free GARAGE KEEPER'S LIEN APPLICATION - Michigan

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Link to Vehicle Code on Michigan Website

GARAGE KEEPER'S LIEN APPLICATION
Garage Keeper Business Name

Street Address City Zip

MI
Repair Facility Number Is Vehicle Still in Your Possession? (Check One)

YES
License Plate Number Vehicle Year Make

NO
Vehicle Identification Number

Clear Form

Name of Vehicle Owner who Authorized Repairs

Street Address

City

State

Zip

Date Repairs Completed

Total Amount of Repairs

Date Storage Charges Began

Total # Days Stored

Total Amount of Storage

$

$

I certify the information and statements on this request are true and correct and comply with the Garage Keeper's Lien Act (Public Act 312 of 1915, as amended), the Motor Vehicle Service and Repair Act (Public Act 300 of 1974), and state and federal driver privacy protection laws. Information from Secretary of State records concerning vehicle ownership is requested for the sole purpose of pursuing legal remedies or recovering a debt from an individual or business. I understand the disclosure of information obtained from Secretary of State records for a purpose other than stated on this request, or the sale or other distribution of information to a person or organization not disclosed in this request may result in penalties imposed under MCL 257.903 and other provisions of law.
Signature Date

Warning: Under Michigan Law, a person who makes a false representation or false certification to obtain personal information or who uses personal information for a purpose other than identified above is guilty of a felony, which may be punishable by imprisonment of up to 15 years, a fine of up to $15,000, or both.

Note: To qualify for a GKL, the vehicle must be titled in Michigan. Mail: · · · To: Michigan Department of State Out of State Resident Services 7064 Crowner Drive Lansing, MI 48918 (517) 322-1473
BDVR-35 (07/01) Authority Granted Under Public Act 312 of 1915, as Amended

Completed application; Itemized account statement showing the name of the person authorizing repairs and/or storage; $10 application fee ­ Make check or money order payable to "State of Michigan".