Free Notice of Aircraft Lien - Connecticut

NOTICE OF AIRCRAFT LIEN
MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. BOX 150470 Hartford, CT 06115-0470 860-509-6002

Office of the Secretary of the State

DELIVERY ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6002
REV. 05/23/2007

SPACE FOR OFFICE USE ONLY

Fee: $25.00 File in duplicate

To all persons whom it may concern, a lien is claimed by me on the below described aircraft:

1. CLAIMANT'S NAME:
IF INDIVIDUAL LAST NAME: FIRST NAME: MIDDLE NAME: SUFFIX:

IF BUSINESS

NAME:

2. CLAIMANT'S ADDRESS:
MAILING ADDRESS (Street or P.O. Box): CITY: STATE: COUNTRY: POSTAL CODE:

3. AMOUNT OF CLAIM 4. NAME OF AIRCRAFT (Write "none" if not applicable) 5. REGISTRATION NUMBER:

6. BASIS OF CLAIM WITH DATES:

7. DESCRIPTION OF AIRCRAFT

(MUST INCLUDE NAME OF MANUFACTURER)

8. LOCATION OF AIRCRAFT 9. OWNER'S NAME:
IF INDIVIDUAL LAST NAME: FIRST NAME: MIDDLE NAME: SUFFIX:

IF BUSINESS

NAME:

10. OWNER'S ADDRESS:
MAILING ADDRESS (Street or P.O. Box): CITY: STATE: COUNTRY: POSTAL CODE:

INTENDED SALE

(If applicable ­ at least 60 days next succeeding filing of such notice)

DATE OF SALE

PLACE OF SALE

CLAIMANT'S SIGNATURE

DATE