Fill and Sign the Agisters Liennotice Asl 3 Form

F. Located At (Insert Legal Description) ( SEAL )Notary Public My commission expires _________________ H. Dated this ___ day of _______, __.G. Contact PersonTelephone # Subscribed and sworn to before me this __ day of __________, ___. Type Name, Company and Title SignatureReserved for Filing Officer Use AGISTER'S LIEN/NOTICE ASL-3 NORTH DAKOTA SECRETARY OF STATE/REGISTERS OF DEEDS SFN 17741 (7-99)PLEASE TYPE. Please read instructions on back before completing. C. Name and Address of Person/Company for Whom Animals Kept If individual, last name firstSSN/TIN:DATE OF POSSESSION ANIMALSQUANTITY $_______________ Price agreed upon for keeping of the animals or if no price was agreed upon, the reasonable value of the services less the amounts received. _______, ___ Date of possession. (Date) (Year) _____________ has been entrusted with the following animals for the purpose of feeding, herding, pasturing or ranching and pursuant to North Dakota Century Code, Chapter 35-17, is claiming a lien upon the following: E.STATEMENT OF LIEND. Name and Address of Person/Company Claiming LienSSN/TIN: Telephone Number:B. Check if to be filed in the notice index and lien index A. Filing Fee Instructions OR Please Bill Customer Billing Number:Check Enclosed SFN 17741 (7-99) ASL-3 INSTRUCTIONSA. B. C. D. E. F. G. H.FILING FEE INSTRUCTIONS: Clients may request to be billed for services. Upon approval a customer number is provided. This number needs to be typed on the form for accurate billing processing. Without a customer number, all fees must be paid at the time of filing. FILE IN: To be checked if the lien is to be filed in both the statutory notice index and statutory lien index. If not checked, lien will be filed in the statutory lien index only. NAME OF PERSON/COMPANY FOR WHOM ANIMALS KEPT: List the name of the person or company, complete mailing address, and social security number or tax identification number for whom the animals were kept. If an individual, enter last name, first name and middle name. NAME OF PERSON CLAIMING LIEN: List the name, mailing address, social security number or tax identification number and telephone number. STATEMENT OF LIEN: List the price agreed upon for keeping the animals or a reasonable value whichever amount is appropriate, less any amounts which have been received. List the name of the person or company keeping the animals. Include a description of the animals, quantity and date of possession. LEGAL DESCRIPTION: List the legal description of where the animals were located. CONTACT PERSON: In order to facilitate the expediting of the filing, provide the name of the appropriate contact person with a telephone number. SIGNATURES AND NOTARIZATION: Have the person sign before a notary public. Type below the signature line the name of the individual, and if signing on behalf of a company, the individual's position with the company and 1. 2. 3. Verify for accuracy and correct spelling. Submit the original and one copy to any register of deeds' office or the Secretary of State's office. Refer to the User's Guide for further information. The Guide may be purchased from the Secretary of State's office. The following letters correspond to the lettered sections on the front of this form. FEES: 1. 2. 3. 4. 5.Filing both Agricultural Lien Index and Notice/Termination Filing only Agricultural Lien Index/Termination Filing only Agricultural Lien Notice/Termination Non-Standard Filing/Termination Additional attachments per typed page$15.00 $15.00 $15.00 $20.00 $ 1.00