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