Instructions: SS-4306 1 | Page Instructions: Form SS-4306 Uniform Commercial Code Fraudulent Lien Notarized Affidavit Business Services Division Tre Hargett, Secretary of State State of Tennessee Submission Options A blank UCC Fraudulent Lien Notarized Affidavit may be obtained by going to sos.tn.gov and entering SS-4306 in the search bar; or by requesting the affidavit from the Secretary of State by emailing TNSOS.UCC@tn.gov ; or by calling (615) 741-3276. In addition, a blank UCC Fraudulent Lien Notarized Affidavit may be obtained in person at the Office of the Secretary of State located at the address listed below. The UCC Fraudulent Lien Notarized Affidavit should be typed or hand printed in ink. Instructions for completing the affidavit are below. A completed Uniform Commercial Code Fraudulent Lien Notarized Affidavit may be submitted for filing either by mail or by hand delivery to the Secretary of State Division of Business Services. If submitting by mail or delivering in person, send or bring the completed and notarized affidavit to: Tennessee Secretary of State ATTN: UCC 312 Rosa L. Parks Ave FL 6 Nashville TN 37243 Fill in the affidavit very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The Office of the Secretary of State cannot give legal advice. Completing the Affidavit Public Official Name: Enter the full legal name of the affiant. Include first name, middle initial and last name. Address: Enter the full address of the affiant. Include the street address, city, state and zip code. Telephone Number: Enter the telephone number of the affiant. Email: Enter the email address of the affiant. American LegalNet, Inc. www.FormsWorkFlow.com Instructions: SS-4306 2 | Page Affidavit: County: Enter the county where the affiant is executing the affidavit. Check the Box: Both boxes must be checked for this affidavit to be filed. First Box: Check this box if you meet the definition of 223Public Official224 as defined by T.C.A. 247 47-9-513(e)(1) T.C.A. 247 47-9-513(e)(1): 223Public Official" is an individual who is a current or retired elected or appointed government official, including a state, county, metropolitan, or municipal official. An individual who is the head of a division or major unit or department within an agency or office of the executive, judicial, or legislative branch of state, county, metropolitan, or municipal government, regardless of the title of the position, and who, as a substantial part of the individual's duties, provides meaningful input on the development of policy goals or the implementation of policy. A high-ranking employee within the executive, judicial, or legislative branch of state, county, metropolitan, or municipal government who has a primary responsibility for one (1) or more of the following functions: Public information and legislative affairs; fiscal, budget, and audit matters; legal, security, or internal affairs; information technology systems; human resources; a first responder, as defined in T.C.A. 247 29-34-203; or a law enforcement officer, as defined in T.C.A. 247 39-11-106. Second Box: By checking this box, I attest that I believe based on my personal knowledge, that the UCC1 Financing Statement identifying me as a debtor was filed without any reasonable basis or legal cause. Explanation: Enter the detailed explanation that outlines the facts as to why the record lacks any reasonable basis or legal cause. If the explanation will not fit in the spaces provided, please attach a detailed explanation and write in the space 223see attached224. Signatures: The Public Official MUST sign the affidavit before a Notary Public. The Notary Public must sign the affidavit, list their commission expiration date and affix their notary seal to the affidavit. Failure to notarize the affidavit will result in the affidavit being rejected. Filing Fee: There is no filing fee required. American LegalNet, Inc. www.FormsWorkFlow.com Tre Hargett en-USSecretary of Stateen-USUNIFORM COMMERCIAL CODE FRAUDULENT LIEN FILING en-USNOTARIZED AFFIDAVITen-USDivision of Business Servicesen-USDepartment of Stateen-USState of Tennesseeen-USATTN: UCCen-US312 Rosa L. Parks AVE, 6th FLen-USNashville, TN 37243-1102en-US(615) 741-3276en-US en-US en-USen-USen-USen-US247 en-USen-USen-USen-US en-USen-US en-USen-US en-USNo Filing Fee Required en-USen-US en-US en-US en-US en-USen-US en-USen-US en-US en-USen-US en-US en-US en-US en-US en-USen-USen-US American LegalNet, Inc. www.FormsWorkFlow.com