SECRETARY OF THE STATE OF CONNECTICUT MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470 DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106 PHONE: 860-509-6002 WEBSITE: www.concord-sots.ct.gov NOTICE OF AIRCRAFT LIEN USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (CONFIRMATION WILL BE SENT TO THIS ADDRESS): CUSTOMER ID: NAME: ADDRESS: FILING FEE: $50 MAKE CHECKS PAYABLE TO "SECRETARY OF THE STATE" CITY: STATE: EMAIL: TO ALL PERSONS WHOM IT MAY CONCERN, A LIEN IS CLAIMED BY ME ON THE BELOW DESCRIBED AIRCRAFT: 1. CLAIMANT'S EXACT LEGAL NAME IF INDIVIDUAL SURNAME OR FIRST PERSONAL NAME BUSINESS BUSINESS NAME MAILING ADDRESS: (STREET OR P.O. BOX) ADDRESS: MIDDLE SUFFIX ZIP: CITY: STATE: 3. AMOUNT OF CLAIM: ZIP: COUNTRY: 4. NAME OF AIRCRAFT (WRITE "NONE" IF NOT APPLICABLE): 5. REGISTRATION NUMBER: 6. BASIS OF CLAIM WITH DATES: 7. DESCRIPTION OF AIRCRAFT (MUST INCLUDE NAME OF MANUFACTURER): 8. LOCATION OF AIRCRAFT: PAGE 1 OF 2 FORM UARC-1-1.1 Rev. 7/2013 9. OWNER'S NAME IF INDIVIDUAL SURNAME OR FIRST PERSONAL NAME BUSINESS BUSINESS NAME 10. MAILING ADDRESS: (STREET OR P.O. BOX) ADDRESS: MIDDLE SUFFIX CITY: STATE: ZIP: COUNTRY: INTENDED SALE (If applicable -- at least 60 days next succeeding filing of such notice) DATE OF SALE CLAIMANT'S SIGNATURE PLACE OF SALE DATE PAGE 2 OF 2 FORM UARC-1-1.1 Rev. 7/2013