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Nt legibly. Carefully follow instructions on page 2. 1a. Contact Name: (optional) Telephone Number: 1b. Send Acknowledgment to: (Name and Address) THE ABOVE SPACE IS RESERVED FOR FILING OFFICE USE ONLY 2. File In: Statutory Agricultural Lien Notice 3. Lessee (Debtor): Provide only one lessee (debtor) name and address of organization or individual leasing land. For best search results, provide exact legal name. 3a. Organization's Name OR First Name 3b. Individual's Last Name 3c. SSN/TIN *.

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