Form UCC-4 "Agriculture Production Input Lien" - Kansas

What Is Form UCC-4?

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

Form Details:

  • Released on June 27, 2016;
  • The latest edition provided by the Kansas 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 UCC-4 by clicking the link below or browse more documents and templates provided by the Kansas Secretary of State.

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Download Form UCC-4 "Agriculture Production Input Lien" - Kansas

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Contact Information
KANSAS SECRETARY OF STATE
UCC-4
Kansas Secretary of State
Agriculture Production Input Lien
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594
All information must be completed or this document will not be accepted for filing.
(785) 296-4564
Please complete the form, print, sign and mail to the
kssos@sos.ks.gov
Print
Kansas Secretary of State with the filing fee. Selecting
www.sos.ks.gov
'Print' will print the form and 'Reset' will clear the entire
Reset
form.
1. Name and residential address of agricultural input purchaser:
Name
Street Address
City
State
Zip
2. Name and address of supplier claiming lien:
Name
Street Address
City
State
Zip
3. Date or anticipated date of furnishing the input:
4. Description of the input:
5. Retail cost or anticipated retail cost of input: $
6. Name and residential address of crop owner (if different from purchaser):
Name
Street Address
City
State
Zip
7. Name and business address of lender:
Name
Street Address
City
State
Zip
8. Description of real estate where crops are growing or will be grown (if applicable):
Note: The products or proceeds of the crops are covered by the lien.
9. Describe livestock and location where they will be or are being raised or fed (if applicable):
Note: The products or proceeds of the livestock are covered by the lien.
Day
Month
Year
Purchaser’s Signature
Date notice sent to lender
Supplier’s Signature
Day
Month
Year
By signing here, the undersigned certifies that the lender has not responded to
the lien notification statement
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Contact Information
KANSAS SECRETARY OF STATE
UCC-4
Kansas Secretary of State
Agriculture Production Input Lien
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594
All information must be completed or this document will not be accepted for filing.
(785) 296-4564
Please complete the form, print, sign and mail to the
kssos@sos.ks.gov
Print
Kansas Secretary of State with the filing fee. Selecting
www.sos.ks.gov
'Print' will print the form and 'Reset' will clear the entire
Reset
form.
1. Name and residential address of agricultural input purchaser:
Name
Street Address
City
State
Zip
2. Name and address of supplier claiming lien:
Name
Street Address
City
State
Zip
3. Date or anticipated date of furnishing the input:
4. Description of the input:
5. Retail cost or anticipated retail cost of input: $
6. Name and residential address of crop owner (if different from purchaser):
Name
Street Address
City
State
Zip
7. Name and business address of lender:
Name
Street Address
City
State
Zip
8. Description of real estate where crops are growing or will be grown (if applicable):
Note: The products or proceeds of the crops are covered by the lien.
9. Describe livestock and location where they will be or are being raised or fed (if applicable):
Note: The products or proceeds of the livestock are covered by the lien.
Day
Month
Year
Purchaser’s Signature
Date notice sent to lender
Supplier’s Signature
Day
Month
Year
By signing here, the undersigned certifies that the lender has not responded to
the lien notification statement
1/2
Instructions
1. If the space provided for any item is inadequate, additional pages may be attached.
2. Mail a copy of this notice by certified mail or another method evidencing date of receipt to the lender
in an envelope marked “IMPORTANT LEGAL NOTICE.”
3. The lender has five business days after receipt of notice to respond with a letter of commitment to
advance part or all of the retail cost stated in the lien notification statement or issue a written refusal to
furnish the letter of commitment.
4. If the lender fails to respond within five business days, file the original form with the secretary of
state within 60 days after the last date that agricultural production input was furnished. The filing fee is
$20.00. Include an additional $1.00 for each page in excess of ten pages.
5. A UCC-1 financing statement must accompany this form. List the “purchaser” as the “debtor” and the
“supplier” as the “secured party” on the UCC-1 form.
Rev. 6/27/16 tc
K.S.A. 58-242
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