______________________________________________________________________________

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]