MONTANA TITLE 71 AGRICULTURAL LIEN FORM FILING FEE=$7.00 Name Address SEND ACKNOWLEDGEMENT TO: At least a 10-point typed font is required when completing this form. This space is for filing use only. Contact Name: Organization Name Individual's Last Name Mailing Address Contact Phone Number: Debtor's Exact Full "Legal" Name (only one debtor name per box) First Name City State Middle Name Postal Code Suffix Country SSN or Tax ID# is required if you want the lien to appear on the Farm Bill Master List distributed to registered buyers. Debtor's Exact Full "Legal" Name (only one debtor name per box) Organization Name Individual's Last Name Mailing Address City First Name State Middle Name Postal Code Suffix Country SSN or Tax ID# is required if you want the lien to appear on the Farm Bill Master List distributed to registered buyers. Secured Party's (Lienor) Exact Full "Legal" Name Organization Name Individual's Last Name Mailing Address Secured Party's Signature Type of Lien and Statutory Authority (check only one) _______ Farm Laborer's Lien (71-3-402) _______ Crop Lien for Seed or Grain (71-3-703) _______ Crop Lien for Spraying or Dusting (71-3-902) _______ Thresher's Lien (71-3-802) _______ Crop Lien for Hail Insurance (71-3-712) (if checked must provide date) _______________________Insurance Date Collateral: This notice covers the following crop(s). Be specific as to the type of crop (i.e., wheat, barley, hay). Specific Farm Product Crop Year Montana County Farm Product Quantity/Description $________________________________________________ Agreed Price, Wage or Value of Service or Products Furnished Value Information (must complete) City First Name State Middle Name Postal Code Suffix Country $________________________________________________ Amount Remaining Unpaid Describe the service or products furnished, period of employment and legal land description where crops were grown, sown and/or planted. http://sos.mt.gov/Business/forms/UCC/Title_71_Form.pdf American LegalNet, Inc. www.FormsWorkFlow.com Revised: 05/2 /2013 COMPLETING TITLE 71 AGRICULTURAL LIEN FORM DEBTOR NAME: Enter only one Debtor name per section. In each section, the debtor can be either an organization name or an individual name but not both. Enter Debtor's exact full legal name. Do not abbreviate. Do not use Debtor's trade name, DBA, AKA, FKA, Division name, etc. in place of or combined with the Debtor's exact full legal name; you may add these other names as additional Debtors. DEBTOR ORGANIZATION: "Organization" means an entity having a legal identity separate from its owner. A partnership is an organization; a sole proprietorship is not an organization, even if it does business under a trade name. If Debtor is a partnership, enter exact full legal name of partnership; you need not enter names of partners as additional Debtors. If Debtor is a registered organization (e.g., corporation, limited partnership, limited liability company), it is advisable to examine Debtor's current filed charter documents to determine debtor correct name. DEBTOR INDIVIDUAL: "Individual" means a natural person; this includes a sole proprietorship, whether or not operating under a trade name. Don't use prefixes (Mr., Mrs., Ms.). Use suffix box only for titles of lineage (Jr., Sr., III) and not for other suffixes or titles (e.g., M.D.). Use married woman's personal name (Mary Smith, not Mrs. John Smith). Enter individual Debtor's family name (surname) in Last Name box, first given name in First Name box, and all additional given names in Middle Name box. DEBTOR TAX ID NUMBER: For the lien to appear on the Farm Bill Master List distributed to registered buyers of farm products you must reflect the debtor's tax identification number. The lien will be accepted without this information and appear for creditors searching the Secretary of State's database but will not be displayed on the Farm Bill Master List. SECURED PARTY SIGNATURE: Each secured party reflected on the Title 71 Lien form is required to sign TYPE OF LIEN & STATUTORY AUTHORITY: Only one lien type may be checked. If Crop Lien for Hail Insurance is checked you must provide the starting date of coverage. VALUE INFORMATION: You must list the agreed price or value of service or products that were furnished. In addition, the remaining amount unpaid must be provided. SPECIFIC FARM PRODUCT: You must list the specific crop subject to the security interest such as wheat, barley, hay, and corn. The listing all "crops" will not suffice. COUNTY: You must provide the county where the farm products are located. CROP YEAR: For a crop grown in soil, the calendar year in which it is harvested or to be harvested. QUANTITY/DESCRIPTION: Provide the number of bushels and detail of crop. Example: 300 bushels of winter wheat. DESCRIBE THE SERVICE/PRODUCT FURNISHED: Provide the type of service or product. For example: Type of fertilizer and how it was applied to the crops. Or the service performed such as threshing, mulching and land planting. FARM LABORER'S LIEN: Must provide the terms and period of employment. SEED OR GRAIN LIEN: Must describe the land upon which seed or grain was or will be sown, planted or used. THRESHER'S LIEN: Must describe the land upon which the grain or crops were grown and the place the grain or crops are presently stored. SPRAYING AND DUSTING LIEN: Must describe the land upon which the service was performed. HAIL INSURANCE LIEN: Must provide the date of insurance coverage. LIEN DURATION: A Title 71 Lien is effective until terminated with the exception of a Crop Lien for Hail Insurance which expires on March 1st of the next succeeding year. ACKNOWLEDGEMENT LETTER: A system derived acknowledgement letter will be returned to you to retain with your records. Please review the information appearing on the acknowledgement letter for accuracy and correct spelling. If you discover a problem contact our office immediately at (406) 444-2468. MAILING ADDRESS: Secretary of State, Attn: UCC th Division, 1236 East 6 Avenue, Helena, Montana 59601 or PO Box 202801, Helena, MT. 59620-2801 TITLE 71 AGRICULTURAL LIEN FILING FEE: Title 71 Lien = $7.00 http://sos.mt.gov/Business/forms/UCC/Title_71_Form.pdf American LegalNet, Inc. www.FormsWorkFlow.com Revised: 08/03/2012