Instructions For Completing The Ucc-11r Request For Certificate Of Information
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1Instructions for completing the
UCC-11R
Request For Certificate Of Information
Please type or print form information. Read all instructions. Follow instructions completely. Complete form
clearly. Be sure to enclose the proper fee amount. A separate UCC-11R form and fee must be submitted
for each debtor name.
Box Numbers
Item Instructions
1. For Office Use Only
Do not write in this box. This is for Filing Officer use
only.
2. Requesting Party
Type or print the name and address of the party
requesting UCC information. To assist filing officers
who might wish to communicate with the requester,
please include a contact person's name and
daytime phone number.
3. Debtor
Enter the legal name and mailing address of the
debtor. Check the PERSONAL or BUSINESS box
to identify the debtor type.
A search fee is required for each debtor name or
name variation you would like searched. Husband
and wife are considered individual debtors and
require separate search requests and fee. Trade
names, DBAs, AKAs, or FKAs are also considered
separate identities. Each name requires its own
request and fee.
Boxes for city and county address information will
reflect all addresses in either the City or County
named on your request. Check the ALL box to
request a search of all addresses on file under the
debtor's name.
Check one box to request certificate of information.
4. Type of Certificate of Information you are
The certification of information type that you
requesting
request, will determine the fee amount.
5. Type of Search you are requesting
Check one box to request search type. List all
relevant filing numbers on the form when you are
requesting copies of specific files.
Mail request forms to:
6. Mailing Address
Uniform Commercial Code
Department of Licensing
PO Box 9660
Olympia WA 98507-9660
Make checks payable to the Department of
Licensing
Private carrier address: 405 Black Lake Boulevard,
First Floor, Olympia WA 98502
The Department of Licensing has a policy of providing equal access to its services. If
UCC11R Req. for Cert. of Info. (R/2/00)M/W Page 1 of 2
you need special accommodation, please call (360)664-1530 or TTY (360)586-2788.
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