EFFECTIVE FINANCING STATEMENT/STATUTORY LIEN STATEMENT OF CONTINUATION AND TERMINATION CNS-3 FORM For Filing Officer STATE OF MINNESOTA This statement is presented for filing pursuant to Minnesota Statutes Chapter 336A. (Type in Black Ink) 1. Original Effective Financing Statement No. Original File Date 2. Original Statutory Lien No. Original File Date 3. Debtor Name and Address Name Street City State (CHOOSE ONE) Zip Code 4. Secured Party/Lienholder and Address Name Street City State Zip Code _____5. EFFECTIVE FINANCING STATEMENT CONTINUATION The original effective financing statement bearing the file number shown in Area Number 1 is still effective and is continued for an additional 5 years. The continuation statement must be signed by the debtor and the secured party or the box below must be marked indicating that the secured party has the signature on file. _____6. EFFECTIVE FINANCING STATEMENT TERMINATION The secured party no longer claims a security interest under the effective financing statement bearing the file number shown in Area Number 1. The date on which the security interest was satisfied is__________________. _____7. STATUTORY LIEN TERMINATION The lien holder no longer claims a lien under the lien notice bearing the file number shown in Area Number 2. The date on which the statutory lien was satisfied is_________________. _____8. TERMINATION AND AMENDMENT This termination is filed pursuant to Minnesota Statutes section 336A.03, Subd. 4 and is accompanied by a new effective financing statement or lien notice as required by that section. I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s) whose signature would be required on behalf of the previous holder of this name, who has authorized me to sign this document on his/her behalf. I further certify that I have completed all required fields, and that the information in this document is true and correct and in compliance with the applicable chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of perjury as set forth in Section 609.48 as if I had signed this document under oath. Name of Contact: Phone Number: RETURN ACKNOWLEDGMENT COPY TO: (name and address) Email Address: Signatures are on file with the secured party. ________________________________________________ Debtor's Signature ________________________________________________ Debtor's Signature ________________________________________________ Lienholder/Secured Party Signature Standard Form Approved by Secretary of State American LegalNet, Inc. www.FormsWorkFlow.com Name Street City State Zip Code Please do not type outside the bracketed area EFFECTIVE FINANCING STATEMENT FOR CONTINUATION AND TERMINATION CNS-3 FORM INSTRUCTIONS THIS STATEMENT MUST BE TYPED OR LEGIBLY PRINTED IN BLACK INK ONLY ILLEGIBLE STATEMENTS WILL BE RETURNED WITHOUT BEING FILED. GENERAL INSTRUCTIONS *Review the form to make sure the information is legible. ILLEGIBLE INFORMATION WILL RESULT IN A REJECTED FILING. *Verify the information on the form for accuracy and correct spelling. SPECIFIC INSTRUCTIONS 1. Provide the correct original effective financing statement file number and date of filing. 2. Provide the correct original statutory lien file number and date of filing. 3. The debtor's name and address must appear as listed on the original effective financing statement/statutory lien notice. 4. The name and address of the secured party/lienholder must appear as listed on the original effective financing statement/statutory lien notice. 5. A continuation statement may be filed by the secured party in the six months prior to the expiration date. The continuation must be signed by both the debtor and the secured party. A statutory lien notice cannot be continued. 6. A termination statement may be filed by the secured party when they no longer claim an interest under the original effective financing statement on which the security interest was satisfied. The secured party is required to list the date on which the security interest was satisfied. 7. A termination statement may be filed by the lienholder when they no longer claim a lien under the original statutory lien notice. The lienholder is required to list the date on which the statutory lien was satisfied. 8. A termination statement may be filed when information has changed and an amendment is necessary. A satisfaction date should not be listed when a termination is filed as part of an amendment. SIGNATURES ARE ON FILE WITH SECURED PARTY: The secured party may check this box to verify that the debtor and/or the signature of the secured party are on file with the secured party. DEBTOR Signature: The debtor is required to sign the effective financing statement continuation. SECURED PARTY/LIENHOLDER SIGNATURE: The secured party is required to sign the effective financing statement continuation and termination. The lienholder is required to sign the statutory lien termination. ACKNOWLEDGMENT NAME AND ADDRESS: Provide a complete name and mailing address where acknowledgment of filing may be sent. Filing Fee Payable to the MN Secretary of State: Effective Financing Statement Continuation - $20 Effective Financing Statement or Statutory Lien Notice Termination - No Fee Retain the original signed copy of this document for your records and submit a photocopy for filing with the Secretary of State. MAIL TO: Minnesota Secretary of State - UCC Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St. Paul, MN 55103 All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service. Rev. 7/2010 American LegalNet, Inc. www.FormsWorkFlow.com