______________________________________________________________________________
LIEN RECORD ABSTRACT
The undersigned states:
A. Creditor/Prevailing Party Information:
__ 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: ______
B. Debtor/Losing Party Information:
__ 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):
_____________________
C. Judgment Information:
__ 1. The amount of the judgment is:
_____________________
__ 2. The amount of the costs is:
_____________________
__ 3. The amount of attorney fees, if any
is: _____________________
D. The Real or Personal Property to Be
Affected
(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: _________
______________________________________________________________________________
(2) A lien record abstract that is the result of a judgment for unpaid child or spousal support entered in another state shall be on the form prescribed by rules adopted by the Department of Justice in lieu of the form required by subsection (1) of this section. [Formerly 18.325; 2009 c.230 §2; 2015 c.197 §3]
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