Fill and Sign the Agricultural Suppliers Liennotice Asl 2 Form

Crops AGRICULTURAL SUPPLIER'S LIEN/NOTICE ASL-2 NORTH DAKOTA SECRETARY OF STATE/REGISTERS OF DEEDS SFN 17899 (7-99) Reserved for Filing Officer Use PLEASE TYPE. Please read instructions on back before completing. C. Name and Address of Person/Company Furnished Supplies (Purchaser) If individual, last name first SSN/TIN: ( SEAL ) Insert a reasonable description, including the county, of the location where the crops, agricultural products, or livestock were grown and the year the crop is to be harvested or was harvested. _________ (Year) G. I. Dated this _______ day of _________________________, _________. H. Contact Person Telephone # STATEMENT OF LIEN The amount of $___________________ , is the amount owing on the purchase of the supplies for which a lien is claimed under North Dakota Century Code, Chapter 35-31. _______________________, _________ The first date the supplier furnished the following agricultural supplies or services for which a lien is claimed: (Date) (Year) E. D. Name and Address of Person/Company Supplying Goods (Supplier) SSN/TIN: Telephone Number: Notary Public My commission expires ____________________________________________ Subscribed and sworn to before me this _______ day of _______________________________, _________. Type Name, Company and Title Signature F. LivestockQty Products Qty Qty 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 17899 (7-99) ASL-2 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.I. 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 FURNISHED SUPPLIES (PURCHASER): List the name of the person or company, complete mailing address, and social security number or tax identification number for whom supplies were furnished. If an individual, enter last name, first name and middle name. NAME OF PERSON SUPPLYING GOODS (SUPPLIER): List the name, mailing address, social security number or tax identification number and telephone number. AGRICULTURAL SUPPLIES/SERVICES: State the amount owing and the first date the supplies or services were furnished. Insert a description of the agricultural supplies sold. This includes seed, petroleum products, fertilizer, farm chemicals, insecticides, feed, hay, pasturage, veterinary services, or the furnishing of services in delivering or applying the supplies. You may include more than one supply on the form. DESCRIPTION/QUANTITY: Describe crops, products, or livestock on which a lien is claimed. Include the quantity subject to the lien, if known. LOCATED: Insert here a reasonable description, including the county, as to the location of the crops, agricultural products, or livestock 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