JUDGMENT LIEN CERTIFICATE
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
SPACE FOR OFFICE USE ONLY
DELIVERY ADDRESS Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6002
Fee: $25.00
1. Judgment Debtors Full Legal Name 1a. ORGANIZATION'S NAME OR 1b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
1c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
2. Additional Judgment Debtors Full Legal Name 2a. ORGANIZATION'S NAME OR 2b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
2c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
3. Judgment Creditors Full Legal Name 3a. ORGANIZATION'S NAME OR 3b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
3c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
4. Additional Judgment Creditors Full Legal Name 4a. ORGANIZATION'S NAME OR 4b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
4c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
5.
Court in which Judgment was rendered
6. Date of Judgment
7. Original Judgment Amount
8. Amount Due
9. Personal Property on which lien is placed
10. Judgment Creditor Signature
11. Date
Reference an 8 ½ x 11 attachment if additional space is required REV. 05/24/2007