Second Judgment Lien Certificate Template
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1SECOND JUDGMENT LIEN CERTIFICATE
FOR PURPOSES OF FILING A SECOND JUDGMENT LIEN, THE FOLLOWING INFORMATION IS
DO NOT PHOTOCOPY THIS FORM PRIOR TO USE.
SUBMITTED IN ACCORDANCE WITH s. 55.204, FLORIDA STATUTES. THIS SECOND JUDGMENT LIEN
BAR CODE MUST BE LEGIBLE.
IS A NEW LIEN AND NOT A CONTINUATION OF THE ORIGINAL LIEN.
1. __________________________________________________________________________________________
FILE NUMBER ASSIGNED TO THE RECORD OF THE ORIGINAL JUDGMENT LIEN CERTIFICATE:
2.
____________________ ,
DATE FILED WITH DEPARTMENT OF STATE
: ___________________________
____________
MONTH
DAY
YEAR
3.
JUDGMENT DEBTOR (DEFENDANT) NAME AS SHOWN ON JUDGMENT, IF AN INDIVIDUAL, IS:
______________________________________________________________________ _____________________________________ _________
LAST NAME
FIRST NAME
M. I.
________________________________________________________________________________________________________________________
MAILING ADDRESS
_______________________________________________________________________________________ __________ ___________________
CITY
ST
ZIP
4.
ADDITIONAL JUDGMENT DEBTOR, IF AN INDIVIDUAL, IS:
_______________________________________________________________________ _____________________________________ ________
LAST NAME
FIRST NAME
M.I.
________________________________________________________________________________________________________________________
MAILING ADDRESS
______________________________________________________________________________________ __________ ____________________
CITY
ST
ZIP
5.
JUDGMENT DEBTOR (DEFENDANT) NAME AS SHOWN ON JUDGMENT, IF A BUSINESS ENTITY, IS:
________________________________________________________________________________________________________________________
BUSINESS ENTITY NAME
________________________________________________________________________________________________________________________
MAILING ADDRESS
______________________________________________________________________________________ __________ ____________________
CITY
ST
ZIP
6.
FEDERAL EMPLOYER IDENTIFICATION NUMBER
: _________________________________________________________________
7.
DEPARTMENT OF STATE DOCUMENT FILE NUMBER
: ______________________________________________________________
PLEASE CHECK BOX IF DOCUMENT NUMBER IS NOT APPLICABLE
8.
JUDGMENT CREDITOR (PLAINTIFF) NAME AS SHOWN ON JUDGMENT OR CURRENT OWNER OF JUDGMENT,
THIS SPACE FOR USE BY FILING OFFICER
:
IF ASSIGNED
__________________________________________________________________________________________
CREDITOR NAME (S)
11. AMOUNT REMAINING UNPAID: $________________________________
__________________________________________________________________________________________
MAILING ADDRESS
APPLICABLE INTEREST RATE: __________________________________
_______________________________________________________________ ________ _______________
CITY
ST
ZIP
9.
DEPARTMENT OF STATE DOCUMENT FILE NUMBER:
INTEREST ACCRUED AMOUNT: $________________________________
______________________________________________________________
12. NAME OF COURT:
PLEASE CHECK BOX IF DOCUMENT NUMBER IS NOT APPLICABLE
________________________________________________________________
10
. OWNER’S ATTORNEY OR AUTHORIZED REPRESENTATIVE: (ACKNOWLEDGMENT OF THIS FILING WILL BE
SENT TO THIS ADDRESS)
________________________________________________________________
_________________________________________________________________________________________
NAME
13. CASE NUMBER: _______________________________________________
_________________________________________________________________________________________
MAILING ADDRESS
14. DATE OF ENTRY: _______________ ____________, _____________
MONTH
DAY
YEAR
______________________________________________________________ _________ ______________
CITY
ST
ZIP
UNDER PENALTY OF PERJURY, I hereby certify that: (1) The judgment above described has become final and there is no stay of the judgment or its enforcement in effect; (2) All of the
information set forth above is true, correct, current and complete; and, (3) I have complied with all applicable laws in submitting this Judgment Lien Certificate for filing.
___________________________________________________________________
_______________________________________________________________________
SIGNATURE OF CREDITOR OR AUTHORIZED REPRESENTATIVE
PRINT NAME
NON-REFUNDABLE PROCESSING FEE:
JUDGMENT LIEN WITH ONE DEBTOR
$20.00
EACH ATTACHED PAGE, IF NECESSARY
$5.00
EACH ADDITIONAL DEBTOR
$ 5.00
CERTIFIED COPY REQUESTED $ 10.00
Division of Corporations • P.O. Box 6250 • Tallahassee, Fl 32314 • 850-245-6011
Make Checks Payable to: Florida Department of State
CR2E092 (3/08)
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