Vehicle Inventory Lender Registration Form MCL 257.235b (4) requires a used or secondhand vehicle inventory lender that holds a certificate of title for a vehicle to register with the Secretary of State. Please complete the information below to

register.

Vehicle Inventory Lender Information

___________________________________________________________ NAME OF VEHICLE INVENTORY LENDER

_______________________________________

ADDRESS

______________________________________________________________ CITY STATE ZIP

____________________________

TELEPHONE NUMBER

Vehicle Inventory Lender Contact Person Information

___________________________________________________

NAME OF CONTACT PERSON

__________________________________ TITLE

_______________________

TELEPHONE NUMBER

_________________________________ E-MAIL ADDRESS

Notice: The vehicle dealer inventory lender is required to release the vehicle title when one of the conditions of MCL 257.235b (2) is met. A used or secondhand vehicle dealer’s inventory lender that fails to release a title as required

under MCL 257.235b (2) may be ordered to pay an administrative fine of $500.00.

__________________________________________ NAME OF PERSON COMPLETING FORM

__________________________________________ TITLE OF PERSON COMPLETING FORM

___________________________________________

SIGNATURE ____________________________

DATE

The completed Vehicle Inventory Lender Registration Form may be faxed to the Business Licensing Section at 517-335-2810, emailed to the Business Licensing Section at

Licensing@Michigan.gov or mailed to the Michigan Department of State, Business Licensing Section, 430 W. Allegan, Lansing, MI 48918.

BLRD – 2 March, 2013