Items (a) through (o) are completed by the Lienholders.
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Fld Name / |
Instruction |
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(a) Name of Borrower |
Enter name of borrower. |
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(b) Name of Co-Borrower |
Enter the name of the co-borrower, if applicable. |
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(c) Town or City of Residence |
Enter the town or city where the borrower(s) are located. |
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(d) County of Residence |
Enter the county where the borrower(s) are located. |
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(e) State of Residence |
Enter the State where the borrower(s) are located. |
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(f) Description of Collateral Affixed to Real Estate |
Describe the Farm Storage Facility Loan collateral that is affixed to real estate. |
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(g) Legal Description of Real Estate Collateral is Affixed To |
Enter the legal description of real estate the collateral is affixed to. |
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(h) Day of Month Agreement Executed |
Enter the numeric day of the month the agreement is executed. |
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(i) Month Agreement Executed |
Enter the month the agreement is executed. |
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(j) Year Agreement Executed |
Enter the year the agreement is executed. |
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(k) Name of Corporate (Mortgagee) (Owner) |
If a corporation holds an interest in the real estate, enter the name of the corporation. Cross out mortgagee or owner, as applicable. Mortgagee includes holder of any type of real estate lien. |
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(l) Signature of Duly Authorized Officer |
Enter the signature of duly authorized officer of the corporation. If you are mailing this form, print the form and manually enter your signature. |
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(m) Title of Duly Authorized Officer |
Enter the title of the duly authorized officer of the corporation. |
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(n) Individual (Mortgagee) (Owner) |
Cross out either mortgagee or owner, as applicable, and enter signature. "Mortgagee" includes holder of any type of real estate lien. |
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(o) Individual (Mortgagee) (Owner) |
Cross out either mortgagee or owner, as applicable, and enter signature. "Mortgagee" includes holder of any type of real estate lien. |
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Corporate Seal |
Affix corporate seal if a corporation holds an interest in the real estate. |
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Items (p) through (w) are to be completed
by a Notary Public. |
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(p) - (w) Acknow-ledgement |
Have the form notarized by a Notary Public. The Notary shall enter: Item (p). Enter the State where the Notary Public is licensed. Item (q). Enter the County where the transaction is being notarized. Item (r). Enter the day the document is notarized. Item (s). The month the document is notarized. Item (t). The year the document is notarized. Item (u). The name(s) of the person(s) who appeared before the Notary. Item (v). The Notary Public's seal or stamp. Item (w). The date the Notary Public's commission expires. |