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Fill and Sign the Fax 503 373 1166 Form

Fill and Sign the Fax 503 373 1166 Form

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442 (Rev. 12/03) 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 ASL -3 Certificate of Cessation of Agricultural Services Lien In keeping with ORS 192.410-192.595, the information on the application is public record. Pursuant to ORS 87.346(4) We must release this information to all parti es upon request and it may be posted on our website. Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary. A. THIS STATEMENT REFERS TO ORIGINAL STATEMENT . ASL File No.: Date Filed: B. DEBTOR : (Name of owner(s) of the cha ttels charged with this lien) MARK ONE If Individual, list last name first. 1 NAME: - Business - Individual 2 NAME: - Business - Individual 3 NAME: - Business - Individual M AILING ADDRESS : CITY STATE ZIPCODE C. N AME OF CLAIMANT (S ): NAME: M AILING ADDRESS : CITY STATE ZIPCODE PHONE NUMBER S TATE OF OREGON , COUNTY OF I, the undersigned certifies and declares with respect to the claim notice of agricultural service lien dated and filed in the office of the Secretary of State that the debt secured thereby has expired and is discharged because no suit to foreclose or proceeding under ORS 87.272 to 87.306 has been filed during the 18 month period following notice to said lien being filed with the Secretary of State. I further certify that I have personally contacted the clerks and circuit courts of the district of lien claim and have determi ned that no suit to foreclose or proceeding under ORS 87.272 to 87.306 has been filed prior to the ex piration of the time period set forth in ORS 87.266(2). The undersigned acknowledges this to be the undersigned’s signature and voluntary act. If the undersigned is a corporation, it has caused its corporate name to be signed by its officers duly authorized by its board of directors. C HATTEL OWNER NAME (if Different) C HATTEL OWNERS SIGNATURE S UBSCRIBED AND SWORN /AFFIRMED BEFORE ME THIS DAY OF , 20 . By: Notary Public of Oregon R ETURN ACKNOWLEDGMENT LETTER TO: (Include name, address, and identifier for the debtor listed above. You may include collateral identifier limited to eight characters.) FEES 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 MasterCa rd. The card number and expiration date should be submitted on a separat e sheet for your protection.

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