Form Miucc7 - Fraudulent Ucc Financing Statement Affidavit - Michigan Department Of State
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2FRAUDULENT UCC FINANCING STATEMENT AFFIDAVIT
Financing Statement must have been filed with the Michigan Secretary of State UCC Office
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. Name & Phone (including area code) of Person Filing This Affidavit
B. SEND ACKNOWLEDGEMENT TO: (Name and Address)
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1. Record to Which This Affidavit Relates:
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1a. RECORD TYPE (Check One) (Found in the upper left hand corner of the
1b. MICHIGAN FINANCING STATEMENT FILING NUMBER
financing statement.)
(Found in the upper right hand corner of the financing statement.
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Example: 2009000001-0)
UCC Financing Statement (UCC1 or UCC1ad)
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UCC Financing Statement Amendment (UCC3 or UCC3ad)
2. Name Of Person Filing This Affidavit - The Record Identified In Item 1 Must Indicate This Person As Debtor.
2a. ORGANIZATION’S NAME
OR
2b. INDIVIDUAL’S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
3. Record is fraudulent. (
Provide a statement explaining why the record identified in Item 1 is fraudulent. Attach extra pages if needed.)
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I certify under penalty of law that the information provided is true, correct, and complete, and I give
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notice that the financing statement referenced above is fraudulent.
: _______________________________________________
______________
: _____________
Affiant Signature
Title:
Date
(The Record Identified In Item 1 Must Indicate This Person As DEBTOR.)
(If representing an organization)
Subscribed and sworn to before me on the ________ day of ____________________, ________
_____________________________________________________________________________
(Notary Public Signature)
_____________________________________________________________________________
(Notary Public Printed Name)
Notary Public, State of Michigan, County of __________________________________________
My commission expires __________________________ Acting in the County of _____________
An individual who files a materially false or fraudulent UCC Financing Statement Affidavit is
guilty of a felony punishable by imprisonment for not more than 5 years or a $2,500 fine, or
both. [MCL 440.9501a(9)]
A recorded Fraudulent UCC Financing Statement Affidavit terminates the identified financing statement. [MCL 440.9501a(3)]
FORM MIUCC7
03/09
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