Form Ucc-11 - Request For Information Or Copies

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REQUEST FOR INFORMATION OR COPIES - UCC-11

NORTH DAKOTA SECRETARY OF STATE / COUNTY RECORDERS

SFN 14005 (01-2012)

Information Request

Follow Instructions (front and back) carefully

Telephone Number:

1a. Contact Name:

1b. Requestor Name and Address:

THE ABOVE SPACE IS RESERVED FOR FILING OFFICE USE ONLY

2. SEARCH CRITERA

CNS & STATUTORY NOTICE ONLY

File Number

Debtor

Secured Party

SSN/TIN

2a. Search By: (Select only one per form)

Complete section

(2b, 2c & 2g - 5)

(2f, 3, 4 & 5)

(2e & 2g - 5)

2b. Select Name Search Type:

General

Specific

2c. Debtor or Secured Party Name to be Searched: Provide only one name (5a or 5b): Name will be searched exactly as requested.

Organization's Name

Middle Name

Individual's Last Name

First Name

Suffix

2d. Search may be limited by one or two city(s) of the debtor or secured party address: (If a city(s) is not listed, the search will reflect all filings).

City 1:

City 2:

2e. Debtor SSN/TIN of CNS and Statutory Lien Notices to be searched: (UCC, MSL, and tax lien filings cannot be searched by SSN/TIN)

2f. File Number(s) to be searched: If an Initial File Number is requested, all associated filings will be included in the results. Additional file numbers need

to be listed on an attached page.

11.

16.

12.

17.

13.

18.

14.

19.

15.

10.

20.

2g. Index selection: Check the box for each index you want to search for the debtor, secured party or SSN/TIN search. (If a box is not checked, all

indexes will be searched).

Statutory Lien

Federal Lien

State Tax

Farm Products

Agricultural Statutory

All

UCC Index

Index

Central Notice

Notice

Liens

2h. Filing status to search: (Select One)

All unlapsed filings as of the certificate date and time

All lapsed and unlapsed filings as of the certificate date and time

All unlapsed filings from Month _________________ Day___________Year___________ to Month ___________________ Day ___________ Year ____________

All unlapsed filings from Month _________________ Day___________Year___________ to Current Date and Time search is run.

3. Information Options: Select one - (All information requests are certified).

Information (only)

Copies (only)

Information and Copies

Certified Copies (only)

Information and Certified Copies

4. Additional Services:

5. Delivery Instructions: (request will be completed and results mailed to the address shown in section 1b unless otherwise instructed here).

Pick up

Fax - Fax number ______________________________________

Other ____________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Specify desired method here (if available from this office); provide delivery information (e.g., delivery service's name, addressee's account number with

delivery service, etc.)