______________________________________________________________________________
LIEN RECORD ABSTRACT
The undersigned states:
__ 1. The creditor/prevailing party is:
_____________________
and the address of the creditor is:
_____________________
_____________________
under judgment, order or petition
entered on _____ (date) in
the _____ Court for
_____ (County) of _____ (State)
under Case No. _____.
__ 2. The creditor's attorney's name is
_____________________
Attorney's Address is:
_____________________
Attorney's Phone No. is: ______
__ 1. The debtor/losing party is:
_____________________
__ 2. Debtor's address (if known):
_____________________
_____________________
__ 3. The final four digits of the debtor's
Taxpayer Identification No.,
or the final four digits of
the debtor's Social Security No.
(if known):
_____________________
__ 4. The final four digits of the debtor's
driver license no. and state of
issuance for the license (if known):
_____________________
__ 5. Name of debtor's attorney
(if known):
_____________________
__ 1. The amount of the judgment is:
_____________________
__ 2. The amount of the costs is:
_____________________
__ 3. The amount of attorney fees, if any
is: _____________________
(Check appropriate box):
__ All real property of the debtor/losing
party, now or hereafter acquired,
in ________ County as provided
under ORS 18.152
__ The following described real or
personal property of debtor (legal
description as set forth or on
attached Exhibit):
_____________________
_____________________
_____________________
_____________________
IN WITNESS WHEREOF, the
undersigned person or persons have
executed this abstract this ___ day
of ______, 2___.
____________ ____________
____________ ____________
State of Oregon | ) |
) | ss. |
County of _____ | ) |
The foregoing instrument was acknowledged before me this ___ day of ___, 2___, by ____________.
__________________
Notary Public for Oregon
My commission expires: _________
State of Oregon | ) |
) | ss. |
County of _____ | ) |
The foregoing instrument was acknowledged before me this ___ day of ___, 2___, by ____________ and by ____________ of ____________, a corporation on behalf of the corporation.
__________________
Notary Public for Oregon
My commission expires: _________
______________________________________________________________________________
ORS 18.170