Fill and Sign the Oregon Certificate Blank Form

441 (Rev. 12/03) Secretary of State Corporation Division - UCC 255 Capitol St. NE, Ste. 151 Salem, OR 97310-1327 Phone: (503) 986-2200 F ax: (503) 373-1166 FilingInOregon.com ASL -2 Certificate of Satisfaction of Discharge 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(1) 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. A. T HIS S TATEMENT R EFERS TO O RIGINAL S TATEMENT . 441 (Rev. 12/03) ASL File No.:       Date Filed:       B. D EBTOR : (Name of owner(s) of the chattels charged with this lien) M ARK O NE If Individual, list last name first. 1 NAME:       - Business - Individual 2 NAME:       - Business - Individual 3 NAME:       - Business - Individual M AILING A DDRESS :                         CITY STATE ZIPCODE 441 (Rev. 12/03)C. N AME OF C LAIMANT ( S ): 1 NAME:       2 NAME:       3 NAME:       The undersigned certifies and declares with respect to the claim of agricultural service lien filed in the office of the Secretary of State that the debt secured thereby is fully paid and satisfied and is discharged. 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 officer duly authorized by its board of directors. 441 (Rev. 12/03)D ATE :       C LAIMANT N AME :       C LAIMANT S IGNATURE :       441 (Rev. 12/03)R ETURN A CKNOWLEDGMENT L ETTER T O : (Include name, address, and identifier for the debtor listed above. You may include collateral identifier limited to eight characters.) 441 (Rev. 12/03) RETURN TO (Please Type or Print within the box):                         FEES No Fee is required to file this form 441 (Rev. 12/03)