Instructions for Fraudulent UCC Financing Statement Affidavit (Form MIUCC7)
Please type or legibly print this form. Follow all instructions. Complete the form carefully; mistakes may have
important legal consequences. If you have questions, consult your attorney. The filing office cannot give legal
Do not insert anything in the open space located on the upper right hand portion of this form; it is reserved for filing
office use only.
This affidavit cannot be filed against a financing statement filed by a regulated financial institution or its
A regulated financial institution is a financial institution subject to regulatory oversight or
examination by a state or federal agency. Regulated financial institution includes, but is not limited to, a bank,
savings bank, savings association, building and loan association, credit union, consumer finance company, industrial
bank, industrial loan company, insurance company, investment company, installment seller, mortgage servicer, sales
finance company, or leasing company.
A. Name & Phone of Person filing This Statement:
affidavit must relate to only one financing statement.
If the filing office needs to contact the filer, provide a
Do not enter more than one file number in item 1b.
name and phone number where the filer may be
reached during normal business hours.
2. Name of PERSON filing this AFFIDAVIT: The
person filing a Fraudulent UCC Financing Statement
Affidavit must be identified as the debtor on the copy
B. Send Acknowledgement To: Enter the name and
of the financing statement sent with the Debtor
address where you want the acknowledgment of
Notification Letter. Only the named debtor may file.
affidavit filing mailed.
If the person is an organization, complete 2a. If the
person is an individual, complete 2b.
1a. Record Type: Check the type of UCC Financing
Statement filed against you as debtor. A copy of the
3. RECORD is fraudulent: Provide a statement
financing statement was sent with the Debtor
explaining why the record identified in Item 1 is
Notification Letter. The record type can be found in
the upper left hand corner of the financing statement.
4. Certification: Read the certification carefully. If
1b. Michigan Financing Statement Filing Number:
you are the person named as debtor in the financing
To terminate the correct record, the filing office
statement sent with the Debtor Notification Letter,
needs the complete Michigan UCC Financing
and you agree with the certification statement, sign
Statement filing number. An example of a filing
and date the Fraudulent UCC Financing Statement
number is 2009000001-0, found in the upper right
If signing for an organization, include
hand corner on the copy of the financing statement
An unsigned or incomplete
that was sent with the Debtor Notification Letter.
Fraudulent UCC Financing Statement Affidavit
The financing statement must have been filed with
will be rejected.
the Michigan Secretary of State UCC Office. This
Mail the completed affidavit to:
Michigan Department of State
PO Box 30197
Lansing, Michigan 48909-7697