AGISTER'S LIEN/NOTICE ASL-3
NORTH DAKOTA SECRETARY OF STATE/COUNTY RECORDERS
SFN 17741 (02-2012)
For reference, see North Dakota Century Code, Chapter 35-17.
Type or print legibly. Carefully follow instructions on Page 2.
1a. Contact Name: (optional) |
Telephone Number: |
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1b. Send Acknowledgment to: (Name and Address)
THE ABOVE SPACE IS RESERVED FOR FILING OFFICE USE ONLY
2. File in (check one) |
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Lien Index Only |
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Lien and Notice Index |
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3.Debtor: Provide only one name of organization or individual (3a or 3b) for whom animals are kept. For best search results, provide exact legal name.
3a. Organization's Name
OR |
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3b. Individual's Last Name |
First Name |
Middle Name |
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Suffix |
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3c. SSN/TIN * |
3d. Mailing Address |
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City |
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State |
Postal Code |
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4.Lienholder (Secured Party): Provide only one name of organization or individual (4a or 4b) and a complete mailing address.
4a. Organization's Name
OR |
4b. Individual's Last Name |
First Name |
Middle Name |
Suffix |
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5. Statement of Lien Pursuant to N.D.C.C., Section 35-17-04:
5a. Price: Price agreed upon for keeping animals or if no price agreed upon, the reasonable value of the services. $
5b. Animals: Describe the animals subject to the lien, the number of animals, and the date of possession.
Animal Description |
Quantity |
Date of Possession |
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3.
4.
5.
5c. Legal Description of Location of Animals:
6. Signature:
Lienholder's (secured party's) signature |
Date |
By |
Title |
SFN 17741 (02-2012)
AGISTER'S LIEN NOTICE ASL-3 INSTRUCTIONS
FEES: All fees must be paid prior to filing with the Secretary of State.
$15 |
… Filing both Lien index and Notice index |
$20 … Non-standard Filing (other than prescribed form or 8 ½ x 11) |
$15 |
… Filing only Lien index |
$ 1 … Per additional attached page (8 ½ x 11) |
FILING OFFICE: Submit the original document to any County Recorder or the Secretary of State.
ACCURACY: Before filing, carefully review for accuracy. The statement must be filed as presented to the filing office. Any inaccuracies can only be corrected by filing an ASL-4 Amendment. No inaccuracies under the Statement of Lien (section5) on this filing can be corrected by an amendment.
ADDENDUMS: If the space provided on the form is inadequate, attach an additional page.
ACKNOWLEDGMENT COPY: An acknowledgment will be sent to the filer at the address provided in section 1b.
The following instructions relate to the numbered sections of this form.
1.CONTACT ADDRESS FOR ACKNOWLEDGMENT:
a.To assist the filing office that may need to contact the filer, provide the name and phone number of the filer. (optional)
b.Provide the mailing address where the filing office will send the acknowledgment copy after filing.
2.Check only one box to indicate the index(es) to which you want your filing entered. (If neither box is checked, the filing will be entered into the Lien Index only!).
3.DEBTOR NAME: Provide only one debtor name in number 3; an organization's name (3a), or an individual's name (3b). For best search results, provide debtor's legal name. Provide the Social Security Number (SSN) or Tax Identification Number (TIN) of the debtor (3c) and a complete mailing address (3d).
PRIVACY: For CNS filings, the SSN/TIN is required by North Dakota law and the Federal Food Security Act of 1985. The number is used to search CNS filings but is not returned in the search results and is redacted from all copies of the record.
4.LIENHOLDER (SECURED PARTY): Provide only one lienholder (secured party) name in number 4: an organization's name (4a), or an individual's name (4b) and a complete mailing address of the lienholder (secured party) (4c).
5.STATEMENT OF LIEN:
a.PRICE: Provide the price agreed upon for keeping the animals or if no price was agreed upon, the reasonable value of the services.
b.ANIMALS: Describe the animals subject to the lien, quantity thereof, and date of possession.
c.LEGAL DESCRIPTION OF LOCATION OF ANIMALS: Provide a legal description where the animals are located.
6.SIGNATURE: The lienholder (secured party) must sign in number 6. If the lienholder (secured party) is an organization, complete the second line with the signor's title or status in the organization.