Instruction For Completing The Ucc-4 Notice Of Lien Filing (Page 2 of 2) in pdf

Instruction For Completing The Ucc-4 Notice Of Lien Filing Page 2

Landlord/Supplier Liens - Provide a clear description of the

8. Landlord/Supplier/Preparer/Processor/Conditioner

labor, service, materials, or supplies furnished.

Preparer/Processor/Conditioner Liens - Provide a clear

description of the agricultural or fish product. Include a

statement of the dollar amount demanded after deduction of

all credits and offsets. (Authority RCW 60.13.040(2)

Supplemental sheets may be used to provide additional

information when there is a lack of space provided in box 8.

Additional sheets should be 8-1/2 x 11 inches. Staple or

paper clip additional sheets to the filing form.

9. Acknowledgment Copies

Acknowledgment copies are normally returned to the lien

holder/claimant shown in box 3, or to the assignee shown in

box 4. Complete the Return Acknowledgment box when you

would like the acknowledgment copy mailed to a party not

shown in boxes 3 or 4.

10. Address

Mail filing forms to:

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

11. For Office Use Only

Do not write in this box. This is for Filing Officer use only.

Provide a clear description identifying the crop and the crop

12. Landlord/Supplier Crop Description

location. (Authority RCW 60.11.040)

Supplemental sheets may be used to provide additional

information when there is a lack of space provided in box

12. Additional sheets should be 8-1/2 x 11 inches. Staple or

paper clip additional sheets to the filing form.

13. Producer's Statement for Preparer/Processor Liens

Filing statement verified, by the producer or fisherman, that

the debt amount is accurate on the lien filing date. Print or

type producer or fisherman name(s) in box 14. The

producer or fisherman must sign in box 16.

(Authority RCW 60.13.040)

14. Name of Lienholder/Claimant/Producer

Print or type the lien holder/claimant/producer name as it

appears in boxes 3 or 4 above the signature line.

15. Processor/Preparer Payment Due Date

Enter the date the payment is due for the agricultural

product or the fish to be charged with the lien.

16. Signature

Lien holder/claimant/producer must sign the form.

The Department of Licensing has a policy of providing equal access to its services. If

UCC-740-004 UCC-4 Notice of Lien (R/2/00) M/W Page 2 of 3

you need special accommodation, please call (360)664-1530 or TTY (360)586-2788.

Instruction For Completing The Ucc-4 Notice Of Lien Filing Page 2

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