Free UCC Secured Party List Request Form - Minnesota

Minnesota Secretary of State
UCC Secured Party Search Request
Company name: _________________________________ Date: ___________________

Contact Person _________________________________ Phone number __________________________ Address _____________________________ City _______________ State _____ Will pick up Return by US Mail Zip _____________

Return by Courier ________________/_______________ name account #

______ Paper List of Secured Party Statewide with debtor information $ 170.00 ______ Paper List of Secured Party Statewide without debtor information $ 150.00

Secured Party to be Searched: (only one name per form please) Organization's Name ________________________________________________________________ Individual's Last Name ________________________ First Name ___________________ M______ Payment Method: Secretary of State client account number _______________________ ACH account number ____________________________ Payment enclosed ======================================================================== PLEASE RETURN THIS REQUEST FORM TO: Minnesota Secretary of State - UCC Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St. Paul, MN 55103

If you have any questions regarding this form, please call 651-296-2803 or dial toll free at 1-877-551-6767.

All of the information on this form is public. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service.

5/2007