"Nebraska Agricultural Production Input Lien Notification Statement" - Nebraska

Nebraska Agricultural Production Input Lien Notification Statement is a legal document that was released by the Nebraska Secretary of State - a government authority operating within Nebraska.

Form Details:

  • Released on April 1, 1999;
  • The latest edition currently provided by the Nebraska Secretary of State;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Secretary of State.

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Download "Nebraska Agricultural Production Input Lien Notification Statement" - Nebraska

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NEBRASKA AGRICULTURAL
For Filing Office Use Only
API
PRODUCTION INPUT LIEN
NOTIFICATION STATEMENT
This Statement must be typed or printed. Illegible Statements will be returned without filing.
This form to be filed with the NE Secretary of State beginning July 1, 1999.
--
2. DEBTOR
--
if Entity
1. DEBTOR
if Individual
Name (Last, First, Middle Initial)
Name
Residential Address
Address
City
State
Zip Code
City
State
Zip Code
Soc. Sec. No. or Fed. Tax I.D. No.
Soc. Sec. No. or Fed. Tax I.D. No.
3. ADDITIONAL DEBTOR
4. SUPPLIER
5. LENDER
(Secured Party)
(Attach additional)
Name
Name
Name
Address
Address
Address
City
State
Zip Code
City
State
Zip Code
City
State
Zip Code
Soc. Sec. No. or Fed. Tax I.D. No.
Soc. Sec. No. or Fed. Tax I.D. No.
Soc. Sec. No. or Fed. Tax I.D. No.
6. This Notification Statement Covers the following described agricultural input and all
7. Date(s) of Transaction
products or proceeds of the crops or livestock covered by the lien.
8. Retail Cost or Anticipated Costs
9. Crop Lien
10. Livestock Lien
of the Agricultural Input
Owner (If individual, list LN, FN, MI)
Owner (If individual, list LN, FN, MI)
$
Owner (Residential) Address
Owner (Residential) Address
11. Signature of Debtor(s) below
City
State
Zip Code
City
State
Zip Code
Description of Real Estate for Crops
Location and Description of Livestock
12. Signature of Supplier(s) below
By
NOTICE TO LENDER:
You are hereby notified of the above described Agricultural Production Input Lien. You have 15 calendar days from the date of receipt of this notice in which to respond with either a letter of
commitment for part or all of the amount in this lien notification statement or a written refusal to issue a letter of commitment.
If the letter of commitment is for only part of the amount or a written refusal to issue a letter of commitment, then a copy of the partial commitment or written refusal shall be sent to the person to whom
the ag production input was furnished or is to be furnished. If you respond in any manner described in said time, your rights under any prior perfected lien under the Uniform Commercial Code shall
retain its priority. If you do not respond to the supplier within 15 calendar days, an Agricultural Production Input Lien corresponding to this lien notification statement has priority over any security interest
statement you might have in livestock and in the crops or their proceeds for the lesser of (1) the amount stated in the lien notification statement; or (2) the unpaid retail cost of the agricultural production
input identified in the lien notification statement.
INSTRUCTIONS
If a response is not received from the lender within 15 calendar days, this statement is then to be filed with the Secretary of State within 3 months after the last date that the agricultural production input
was furnished. If the space provided for any items on this form is inadequate, the item(s) may be continued on additional 8 ½ inch by 11 inch sheets of paper.
When the form is completed and signed you should remove the second page and send it to the lender by certified mail or another verifiable method. If there are multiple lenders you should photocopy
that page and mail it to all of them. Mark the envelope “IMPORTANT - LEGAL NOTICE”.
In order to perfect the agricultural production input lien, the lien must attach and the supplier entitled to the lien must file the lien notification statement with the Secretary of State - UCC Division, P O
Box 95104, Lincoln, NE 68509. Lienholder will receive an acknowledgment from the Secretary of State.
     1999 N
C
C
EBRASKA
OOPERATIVE
OUNCIL
C
:
134 S
13
S
S
314
OUTH
TH
TREET
UITE
OPIES TO EACH OF THE FOLLOWING
SECRETARY OF STATE - W
C
LENDER - G
C
SUPPLIER - C
C
DEBTOR - P
C
L
NE 68508-1901
HITE
OPY
REEN
OPY
ANARY
OPY
INK
OPY
INCOLN
(402) 475-6555
Approved by the Secretary of State (
4-99)
REVISED
NEBRASKA AGRICULTURAL
For Filing Office Use Only
API
PRODUCTION INPUT LIEN
NOTIFICATION STATEMENT
This Statement must be typed or printed. Illegible Statements will be returned without filing.
This form to be filed with the NE Secretary of State beginning July 1, 1999.
--
2. DEBTOR
--
if Entity
1. DEBTOR
if Individual
Name (Last, First, Middle Initial)
Name
Residential Address
Address
City
State
Zip Code
City
State
Zip Code
Soc. Sec. No. or Fed. Tax I.D. No.
Soc. Sec. No. or Fed. Tax I.D. No.
3. ADDITIONAL DEBTOR
4. SUPPLIER
5. LENDER
(Secured Party)
(Attach additional)
Name
Name
Name
Address
Address
Address
City
State
Zip Code
City
State
Zip Code
City
State
Zip Code
Soc. Sec. No. or Fed. Tax I.D. No.
Soc. Sec. No. or Fed. Tax I.D. No.
Soc. Sec. No. or Fed. Tax I.D. No.
6. This Notification Statement Covers the following described agricultural input and all
7. Date(s) of Transaction
products or proceeds of the crops or livestock covered by the lien.
8. Retail Cost or Anticipated Costs
9. Crop Lien
10. Livestock Lien
of the Agricultural Input
Owner (If individual, list LN, FN, MI)
Owner (If individual, list LN, FN, MI)
$
Owner (Residential) Address
Owner (Residential) Address
11. Signature of Debtor(s) below
City
State
Zip Code
City
State
Zip Code
Description of Real Estate for Crops
Location and Description of Livestock
12. Signature of Supplier(s) below
By
NOTICE TO LENDER:
You are hereby notified of the above described Agricultural Production Input Lien. You have 15 calendar days from the date of receipt of this notice in which to respond with either a letter of
commitment for part or all of the amount in this lien notification statement or a written refusal to issue a letter of commitment.
If the letter of commitment is for only part of the amount or a written refusal to issue a letter of commitment, then a copy of the partial commitment or written refusal shall be sent to the person to whom
the ag production input was furnished or is to be furnished. If you respond in any manner described in said time, your rights under any prior perfected lien under the Uniform Commercial Code shall
retain its priority. If you do not respond to the supplier within 15 calendar days, an Agricultural Production Input Lien corresponding to this lien notification statement has priority over any security interest
statement you might have in livestock and in the crops or their proceeds for the lesser of (1) the amount stated in the lien notification statement; or (2) the unpaid retail cost of the agricultural production
input identified in the lien notification statement.
INSTRUCTIONS
If a response is not received from the lender within 15 calendar days, this statement is then to be filed with the Secretary of State within 3 months after the last date that the agricultural production input
was furnished. If the space provided for any items on this form is inadequate, the item(s) may be continued on additional 8 ½ inch by 11 inch sheets of paper.
When the form is completed and signed you should remove the second page and send it to the lender by certified mail or another verifiable method. If there are multiple lenders you should photocopy
that page and mail it to all of them. Mark the envelope “IMPORTANT - LEGAL NOTICE”.
In order to perfect the agricultural production input lien, the lien must attach and the supplier entitled to the lien must file the lien notification statement with the Secretary of State - UCC Division, P O
Box 95104, Lincoln, NE 68509. Lienholder will receive an acknowledgment from the Secretary of State.
     1999 N
C
C
EBRASKA
OOPERATIVE
OUNCIL
C
:
134 S
13
S
S
314
OUTH
TH
TREET
UITE
OPIES TO EACH OF THE FOLLOWING
SECRETARY OF STATE - W
C
LENDER - G
C
SUPPLIER - C
C
DEBTOR - P
C
L
NE 68508-1901
HITE
OPY
REEN
OPY
ANARY
OPY
INK
OPY
INCOLN
(402) 475-6555
Approved by the Secretary of State (
4-99)
REVISED