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Garage Keepers' Lien Financing Statement
Registration Details
Note: In these questions, the words "you" and "your" refer to the person claiming the lien.
1. Did you repair or store the vehicle?
a. Do you still have possession of the vehicle?
No
Yes
If yes, complete the following:
No
Yes
If yes, proceed to question 3.
yyyy/mm/dd
b. If repaired or stored on your premises, when did you release it?
yyyy/mm/dd
c. If repaired off your premises, when did you finish the repairs?
No
2. Did you provide accessories or parts for the vehicle?
Yes
If yes, when were
they provided:
yyyy/mm/dd
$
3. How much is the lien (in dollars and cents)?
Vehicle Owner(s)
Select one
Owner 1
Business
Individual
First Name
Business Name or Last Name
Street Address
City
Select one
Owner 2
Business
Province
Postal Code
Individual
First Name
Business Name or Last Name
Street Address
Birthdate (if known)
yyyy/mm/dd
Middle Name
Birthdate (if known)
yyyy/mm/dd
Middle Name
City
Province
Postal Code
Person Claiming Lien
Select one
Secured
Party Code
Business
Individual
Business Name or Last Name
Street Address
First Name
City
Middle Name
Province
Postal Code
Describe Motor Vehicle, Farm Vehicle, Aircraft or Boat
Serial Number
Year (yyyy) Make and Model
Category
Your Reference Number
Authorized Signature
REG3326 (2002/11)
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Name of Person Authorized to Complete this Form (PRINT)
Registry Agent Office Use Only
Telephone number
Call Box Number
Date of Submission (yyyy/mm/dd)
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