Office of the Minnesota Secretary of State UCC/Tax Lien Initial Dataset Request This form must be submitted with a signed UCC Bulk Order Request License Agreement. Read the instruction before completing this form. Note: This order does not include images. Company Name Contact Name Phone Number Address Email Address Signature Order City State Zip FEE Date Products UCC Financing Statements and Tax Lien Statements Initial Dataset UCC Financing Statements Initial Dataset Only Tax Lien Statements Initial Dataset Only $12,000 $9,600 $2,400 Payment Method Payment method is by check only Make check payable to the MN Secretary of State American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS The UCC and Tax Lien Initial Dataset file will be provided in an Excel spreadsheet in a single file. The file will be in a commadelimited format (CSV). Each field will be encapsulated with double quotes regardless of the datatype. An email notification will be sent to the email address listed on the request form. The email will include a link to the Initial Dataset file. You will view this information in your "Download Inventory" located in the Minnesota Business and Lien System (MBLS). To obtain updates for data and/or images you will need to register online http://mblsportal.sos.state.mn.us/ and purchase weekly subscriptions. Weekly subscriptions for data and/or images will be each week. Note: Image purchase is not available for Tax Liens. To order the UCC Financing Statement and Tax Lien database you must sign the UCC Database License Agreement. The License Agreement can be obtained online at http://mblsportal.sos.state.mn.us/ . Please make check payable to the MN Secretary of State. Mail form, signed license agreement and fee to: Minnesota Secretary of State ­ UCC Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St. Paul, MN 55103 If you have any questions, please call 6512962803 (Twin Cities area); or 18775616767 (Greater Minnesota) and press option 4 for assistance. Phone lines are open between 9 a.m. and 4 p.m. Monday ­Friday, excluding holidays. 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)2962803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 18006273529 and ask them to place a call to (651)2962803. 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.12/4/2014 American LegalNet, Inc. www.FormsWorkFlow.com