Tax Lien Standard Search Or Copy Request {UCC-12}

Office of the Minnesota Secretary of State Tax Lien Standard Search or Copy Request This statement is presented pursuant to Minnesota Statute Sections 270C.63 and 272.483. A tax lien standard search or copy request will consist of records filed with the Office of the Secretary of State only. You should contact the county if you need to conduct any additional searches or order copies of tax liens filed at the county level pursuant to Minnesota Statute 270C.63, subd.13 and 272.483, clause (d). Return Requested Information to: Company Name Contact Name Phone Number Address City State Zip Email Address (for email delivery) Information listing only Includes state and federal tax liens showing all taxpayer names and addresses, filing information and description of subsequent filings for liens filed in the Office of the Secretary of State. Copies only Includes state and federal tax liens showing the file number, the file date and copies of the tax liens filed in the Office of the secretary. Combination information and copies Includes data as described in information option and copies of the tax liens that are filed in the Office of the Secretary of State. American LegalNet, Inc. www.FormsWorkFlow.com Please furnish search certificate showing tax liens as of: date of processingfrom to date of processing List taxpayer name below: (Only one name can be searched per form and may limit search by city and date range) Taxpayer Organization Name or Taxpayer Individual222s Last Name First Name M City, if any Date Range Start Date, if any Date Range End Date, if any The fee for ordering tax lien copies is $3.00 per file number, plus an additional File Number File Number File Number Please make check payable to the MN Secretary of State and mail form and fee to: Office of the Minnesota Secretary of State - UCC Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St. Paul, MN 55103 If you have any questions, please call 651-296-2803 (Twin Cities area); or 1-877-561-6767 (Greater Minnesota) and press option 4 for assistance. Phone lines are open between 9 a.m. and 4 p.m. M-F excluding holidays. All of the information on this form is public. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service. Rev/201UCC12Form American LegalNet, Inc. www.FormsWorkFlow.com