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
Notice of Filing Extension of Grain Producer's Lien
Pursuant to ORS 87.762
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.
1 NAME 2 NAME
If Individual, list last name first.
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. swear/affirm that the amount claimed on this Notice is true and bona fide existing
COUNTY OF SUBSCRIBED TO AND SWORN/AFFIRMED BEFORE ME THIS
, 20 by
Notary Public of Oregon
My commission expires:
RETURN TO (Please Type or Print within the box):
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.
450 (Rev. 8/02)