INFORMATION REQUEST Type or Print This Form
FOLLOW INSTRUCTION PAGE CAREFULLY A. NAME & PHONE OF CONTACT B. ACCOUNT #
C. RETURN TO: (Name & Address)
D. SEARCH TYPE: E. DELIVERY INSTRUCTIONS: EXPEDITED (Additional Fee) REGULAR MAIL
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
REGULAR PICK UP EXPRESS MAIL (See Below)
EXPRESS MAIL NAME ___________________________________________ EXPRESS ACCOUNT # ______________________________________ 1. DEBTOR NAME TO BE SEARCHED Insert only one debtor name (1a or 1b) Do not abbreviate or combine names 1a. ORGANIZATION'S NAME
1b. INDIVIDUAL'S LAST NAME
2. DOCUMENT OPTIONS: All (Includes lapsed financing statements) 3. SEARCH OPTIONS: 3a. 3b. 3c. 3d. SEARCH CERTIFICATE Furnish a listing of financing statements and tax liens. No copies are provided. SEARCH CERTIFICATE and COPIES Furnish a listing and copies of financing statements and tax liens. FACE COPIES Furnish copies of the FIRST PAGE ONLY of financing statements and tax liens. SPECIFIC COPIES Furnish copies of each page of the financing statements, identified below by document file number. RELATED SUBSEQUENT DOCUMENTS FILE NUMBER DATE FILED FILE NUMBER DATE FILED Unlapsed
LISTING AND COPIES FOR SPECIFIC TIME PERIOD ONLY BEGINNING DATE _______________________________________________ ENDING DATE __________________________________________ INCLUDE RELATED DOCUMENTS OUTSIDE TIME PERIOD
LISTING AND COPIES FOR SPECIFIC CITY Identify the city to be searched: ___________________________________________________________________________________________________________________
LIMIT COPIES State the number of copies to limit your search. Copies cannot be limited to less than 100 pages. If copies exceed limit stated, a listing only search will be performed. To obtain copies, submit a new search request. CERTIFIED SEAL Additional fee required.
FILING OFFICE COPY MICHIGAN INFORMATION REQUEST (FORM UCC11, REV. 11/04/04)
INSTRUCTIONS FOR MICHIGAN INFORMATION REQUEST FORM UCC11
Please type or print this form. Be sure it is completely legible. Follow instructions completely. Carefully fill out this form; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give legal advice. When the form is complete, send the Filing Office Copy with required fee, to the filing office. A. NAME & PHONE OF CONTACT: Name and phone number for the contact person is required.
B. ACCOUNT NUMBER: If you have an established Michigan Uniform Commercial Code billing account number, enter the
number in this box.
C. RETURN TO (Name and Address): The name and address of requestor is required. D. SEARCH TYPE, EXPEDITED OR REGULAR: Mark the appropriate box. Expedited search fees are an additional $25,
per Debtor name. All fax or telephone search requests are processed as expedited and must include an account number. Regular fees are $6 per Debtor name and must be submitted in person or by mail. Copy fees are $2 per page.
E. DELIVERY INSTRUCTIONS, REGULAR MAIL, PICK UP or EXPRESS MAIL: Mark the appropriate box. Expedited counter pick-ups are available after 3:00 p.m. For express mail, remember to give the express mail company name and account number. If no box is checked, the search will be returned by regular mail. 1. DEBTOR NAME: Enter only one Debtor name in item 1. Enter Debtor's exact full legal name. Do not abbreviate. The Debtor can be an organization or an individual, but not both. If you want to search both an organization and an individual who is a principal, two search requests are needed. 1a. ORGANIZATION'S NAME: An entity having a legal identity separate from its owner. A partnership is an organization; a sole proprietorship is not an organization, even if it does business under a trade name. If the Debtor is a partnership, enter exact full legal name of the partnership; you do not need to enter names of partners as additional Debtors. If Debtor is a registered organization, like a corporation, limited partnership, or limited liability company, look at the Debtor's filed charter documents to determine the correct name, organization type, jurisdiction and identification number. 1b. INDIVIDUAL'S NAME: A natural person including a sole proprietorship, whether or not operating under a trade name. Do not use prefixes like Mr., Mrs., or Ms. Use suffix box only for titles of lineage like Jr., Sr., or III and not for other suffixes like M.D. Use a married woman's personal name like Mary Smith, not Mrs. John Smith. Enter individual Debtor's family name or surname in Last Name box, first given name in First Name box and all additional given names in Middle Name box. For both ORGANIZATION and INDIVIDUAL Debtors: Do not use trade names like DBA, AKA, FKA or the Division name in place of or combined with Debtor's legal name. For example, do not use "Simpson Motor Inc. DBA Cornelia Car City" or "John Smith DBA Smith's Coffee Shop". Search results from such requests may not give financing statements on file that correctly use the legal name of the Debtor. 2. DOCUMENT OPTIONS: Check either the All or Unlapsed box. When the option "All" is marked, lapsed financing statements are given for one year after the date the financing statement would have lapsed. When the option "Unlapsed" is marked, only unlapsed financing statements are reported.
3. SEARCH OPTIONS: The Michigan Department of State UCC Office offers all the additional services listed in item 3. Check the appropriate option or options. Include additional information, if applicable. To request an update search, state "current" or "certification date" on the second line after box 3e. Check the second box after 3e to include copies of related documents outside the time range specified. For examples, if this box is checked, for an amendment financing statement filed within the time period specified, the related initial financing statement is included in the search results. For certified seals, typically used in court proceedings, an additional fee is charged. 4. Submit the completed UCC11 by Regular Mail: Michigan Department of State UCC Office PO Box 30197 Lansing, MI 48909-7697 In Person or Express Mail: Michigan Department of State UCC Office 7064 Crowner Drive Dimondale, MI 48821