Free UCC Notice of Agricultural Produce Lien Form APL-1 - Oregon


File Size: 98.3 kB
Pages: 1
Date: June 28, 2005
File Format: PDF
State: Oregon
Category: UCC Forms
Author: Oregon Secreary of State Corporation Division
Word Count: 240 Words, 1,508 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.filinginoregon.com/forms/pdf/ucc/430.pdf

Download UCC Notice of Agricultural Produce Lien Form APL-1 ( 98.3 kB)


Preview UCC Notice of Agricultural Produce Lien Form APL-1
Secretary of State Corporation Division - UCC 255 Capitol St. NE, Ste. 151 Salem, OR 97310-1327 Phone: (503) 986-2200 Fax: (503) 373-1166 FilingInOregon.com

APL -1
DEBTOR

Notice of Agricultural Produce Lien

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Pursuant to ORS 87.710

In keeping with ORS 192.410-192.595, the information on the application is public record. We must release this information to all parties upon request and it may be posted on our website. Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary.

Mark One

If Individual, list last name first.

PURCHASER: NAME 1
NAME 2

-Business -Business

-Individual -Individual

ADDRESS

CITY

STATE

ZIPCODE

PRODUCER:
NAME

ADDRESS

CITY

STATE

ZIPCODE

STATEMENT AMOUNT OF PRODUCER'S DEMAND (after Deducting All Credits and Offsets) : $ DESCRIPTION OF PRODUCE DELIVERED OR TRANSFERRED BY:

DATE PAYMENT ORIGINALLY DUE: I (WE) debt as of the date of this filing. STATE OF COUNTY OF SUBSCRIBED TO AND SWORN/AFFIRMED BEFORE ME THIS swear/affirm that the amount claimed on this Notice is a true and bona fide existing

CLAIMANT SIGNATURE

DATE

DAY OF

, 20 by

,

Notary Public of Oregon

My commission expires:

RETURN TO (Please Type or Print within the box):

FEES
Required Processing Fee - $10 Processing Fees are nonrefundable. Please make check payable to "Corporation Division." NOTE: Fees may be paid with VISA or MasterCard. The card number and expiration date should be submitted on a separate sheet for your protection.

430 (Rev. 8/02)