Form UCC57 "Affidavit of Fraudulent Record" - Illinois

What Is Form UCC57?

This is a legal form that was released by the Illinois Secretary of State - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2012;
  • The latest edition provided by the Illinois Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form UCC57 by clicking the link below or browse more documents and templates provided by the Illinois Secretary of State.

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Download Form UCC57 "Affidavit of Fraudulent Record" - Illinois

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UCC
Form
Uniform Commercial Code
August 2012
Affidavit of Fraudulent Record
Secretary of State
Department of Business Services
UCC Division
SUBMIT IN DUPLICATE
501 S. Second St., Rm. 350W
Springfield, IL 62756
Type or Print Clearly.
This space for use by Secretary of State.
www.cyberdriveillinois.com
File Number:
Date:
Approved:
This space for use by Secretary of State.
1.
Affiant Name: ______________________________________________________________
2.
Financing Statement/Amendment Number Listing Affiant as a Debtor:
3.
I hereby affirm my reasonable belief that the aforementioned filing (initial each):
a. _____ is not authorized or permitted under Section 9-509, 9-708, or 9-808 of the Uniform
Commercial Code (810 ILCS 5);
b. _____ is not related to a valid existing or potential commercial or financial transaction, an
existing agricultural or other lien, or a judgment of a court of competent jurisdiction; and
c. _____ is filed with intent to harass or defraud me and/or other person(s).
4.
The undersigned affirms, under penalties of perjury, that the facts stated herein are true,
correct and complete.
______________________________________
________________
________________
Signature of Affiant
Month & Day
Year
Affiant Contact Information (please type or print clearly):
__________________________________________
Name
__________________________________________
Street
__________________________________________
City
State
ZIP
____________________________________
Telephone Number
____________________________________
Email Address
Printed by authority of the State of Illinois. November 2012 — 1 — UCC 57.1
Print
Reset
Save
UCC
Form
Uniform Commercial Code
August 2012
Affidavit of Fraudulent Record
Secretary of State
Department of Business Services
UCC Division
SUBMIT IN DUPLICATE
501 S. Second St., Rm. 350W
Springfield, IL 62756
Type or Print Clearly.
This space for use by Secretary of State.
www.cyberdriveillinois.com
File Number:
Date:
Approved:
This space for use by Secretary of State.
1.
Affiant Name: ______________________________________________________________
2.
Financing Statement/Amendment Number Listing Affiant as a Debtor:
3.
I hereby affirm my reasonable belief that the aforementioned filing (initial each):
a. _____ is not authorized or permitted under Section 9-509, 9-708, or 9-808 of the Uniform
Commercial Code (810 ILCS 5);
b. _____ is not related to a valid existing or potential commercial or financial transaction, an
existing agricultural or other lien, or a judgment of a court of competent jurisdiction; and
c. _____ is filed with intent to harass or defraud me and/or other person(s).
4.
The undersigned affirms, under penalties of perjury, that the facts stated herein are true,
correct and complete.
______________________________________
________________
________________
Signature of Affiant
Month & Day
Year
Affiant Contact Information (please type or print clearly):
__________________________________________
Name
__________________________________________
Street
__________________________________________
City
State
ZIP
____________________________________
Telephone Number
____________________________________
Email Address
Printed by authority of the State of Illinois. November 2012 — 1 — UCC 57.1