Free Microsoft Word - ucc notive of vessel lien.DOC - Connecticut

NOTICE OF VESSEL LIEN
Office of the Secretary of the State
MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. BOX 150470 Hartford, CT 06115-0470 860-509-6002 C.G.S. §49-55a 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 vessel:

1. OWNER'S EXACT LEGAL NAME
IF LAST NAME INDIVIDUAL IF NAME ORGANIZATION MAILING ADDRESS (Street or P.O. Box) FIRST NAME MIDDLE NAME SUFFIX

CITY

STATE

COUNTRY

POSTAL CODE

2. CLAIMANT'S EXACT LEGAL NAME
IF LAST NAME INDIVIDUAL IF NAME ORGANIZATION MAILING ADDRESS (Street or P.O. Box) FIRST NAME MIDDLE NAME SUFFIX

CITY

STATE

COUNTRY

POSTAL CODE

3. NAME OF VESSEL

4. REGISTRATION NUMBER

5. DESCRIPTION OF VESSEL AND NAME OF MANUFACTURER

6. HULL NUMBER 8. TYPE OF PROPULSION 9. LENGTH

7. REGISTRATION NUMBER

10. LOCATION OF VESSEL 11. AMOUNT OF CLAIM 12. BASIS OF CLAIM WITH DATES

INTENDED (If applicable ­ at least 60 days next SALE succeeding filing of such notice)
CLAIMANT'S SIGNATURE

DATE OF SALE

PLACE OF SALE

DATE