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Form 12a502 - Application For Certificate Of Subordination Of Kentucky Department Of Revenue Lien Page 2

Name and address of financial institution from which you are obtaining loan? Please attach a

letter from the institution stating the exact amount of the loan; also, indicate if this is a business

loan or other type of loan. Your application will not be processed without this information.

__________________________________________________________________________________

AMOUNT OF LOAN: $__________________________ (Attach proposed Closing Statement if it

has been prepared.)

Legal description (including Book and Page Number of the Deed) and street address or location

of real property to be used as collateral; complete description and identifying numbers of

personal property to be used as collateral. Attach additional sheets if necessary. If attachments

are used, UNDERLINE the EXACT description of the property AS IT IS TO APPEAR ON THE

CERTIFICATE.

__________________________________________________________________________________

Attach accurate copies of ONLY THOSE LIEN(S) which you are requesting to be subordinated. IF

SAID LIENS ARE NOT ATTACHED, THIS APPLICATION CANNOT BE PROCESSED AND WILL BE

HELD WITH NO ACTION TAKEN UNTIL THE REQUIRED LIEN(S) ARE SUBMITTED.

List all recorded lien(s) and mortgages which are superior to Kentucky Department of Revenue

lien(s). (Additional space is provided on the next page.)

(1)

(2)

(3)

Name &

____________________

Address:

____________________

Description:

____________________

Date Recorded:

____________________

*Amount Due:

____________________

Form 12a502 - Application For Certificate Of Subordination Of Kentucky Department Of Revenue Lien Page 2