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Fill and Sign the Phone 503 986 2200 Form

Fill and Sign the Phone 503 986 2200 Form

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441 (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 -2 Certificate of Satisfaction of Dischar ge 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 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. T HIS 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 MAILING ADDRESS : CITY STATE ZIPCODE C. NAME OF CLAIMANT (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 fu lly 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 offi cer duly authorized by its board of directors. D ATE : CLAIMANT NAME : CLAIMANT SIGNATURE : R ETURN ACKNOWLEDGMENT LETTER TO: (Include name, address, and identifier for the debtor lis ted above. You may include collateral identifier limited to eight characters.) FEES RETURN TO (Please Type or Print within the box): No Fee is required to file this form

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