Fill and Sign the Agricultural Processors Liennotice Asl 1 Form

Reserved for Filing Officer Use AGRICULTURAL PROCESSOR'S LIEN/NOTICE ASL-1 NORTH DAKOTA SECRETARY OF STATE/REGISTERS OF DEEDS SFN 17900 (7-99) C. Name and Address of Person/Entity for Whom Processing Was Done (Purchaser) If individual, last name first SSN/TIN: PLEASE TYPE. Please read instructions on back before completing. B. Check if to be filed in the notice index and lien index A. Filing Fee Instructions OR Please Bill Customer Billing Number: ( SEAL ) Notary Public My commission expires ____________________________________________ Insert a reasonable description, including the county, of the location where the crops or agricultural products were grown and the year the crop is to be harvested or was harvested. _________ (Year) G. I. Dated this _______ day of _________________________, _________.STATEMENT OF LIEN $_____________________________ Price agreed upon for the processing or if no price was agreed upon, the reasonable value of the processing. ____________________, ________ First date services were furnished and description of processing services furnished. (Date) (Year) _________________, _______ Date processing was completed. Pursuant to NDCC, Chapter 35-30, Processor is claiming a lien upon the following: (Date) (Year) E. Crops Products Qty Qty F. D. Name and Address of Processor SSN/TIN: Telephone Number: H. Contact Person Telephone # Subscribed and sworn to before me this _______ day of _______________________________, _________. Type Name, Company and Title Signature Check Enclosed SFN 17900 (7-99) ASL-1 INSTRUCTIONS 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. A. 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 PROCESSING WAS DONE (PURCHASER): List the name of the person or company, complete mailing address, and social security number or tax identification number for whom processing was done. If an individual, enter last name, first name and middle name. NAME OF PROCESSOR: List the name, mailing address, social security number or tax identification number and telephone number. STATEMENT OF LIEN: If a price was agreed upon, insert the amount, or if no amount was agreed upon, insert the reasonable value of the processing. Insert the first date the processing services were furnished and describe the processing services furnished. Insert the date processing was completed. DESCRIPTION/QUANTITY: Here insert a description of the crops or agricultural products and their amount, if known, upon which you claim a lien. For example, 5000 bushels of spring wheat. A lien upon anything other than the crop or product processed is void. LOCATED: Insert here a reasonable description, including the county, of the property where the crops or products were grown and the year the crop is to be harvested or was harvested. 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 the name of the company. 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