SECRETARY OF THE STATE OF CONNECTICUT
MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470
DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106
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PHONE: 860-509-6002 |
WEBSITE: www.concord-sots.ct.gov |
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JUDGMENT LIEN CERTIFICATE |
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USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. |
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FILING PARTY (CONFIRMATION WILL BE SENT TO THIS ADDRESS): |
FILING FEE: $50 |
CUSTOMER ID: |
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NAME: |
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MAKE CHECKS PAYABLE TO "SECRETARY |
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OF STATE" |
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ADDRESS: |
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CITY: |
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STATE: |
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1. JUDGMENT DEBTORS FULL LEGAL NAME |
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1A. ORGANIZATION’S NAME |
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OR |
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1B. INDIVIDUAL'S |
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LAST NAME |
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FIRST NAME |
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MIDDLE |
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SUFFIX |
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1C. MAILING ADDRESS: |
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ADDRESS: |
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CITY: |
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COUNTRY: |
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2. ADDITIONAL JUDGMENT DEBTORS FULL LEGAL NAME |
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2A. ORGANIZATION’S NAME |
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OR |
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2B. INDIVIDUAL’S |
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LAST NAME |
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FIRST NAME |
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MIDDLE |
SUFFIX |
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2C. MAILING ADDRESS: |
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ADDRESS: |
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CITY: |
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FORM UJPERS-1-1.0 |
PAGE 1 OF 2 |
Rev. 7/2010 |
3. JUDGMENT CREDITORS FULL LEGAL NAME
3A. ORGANIZATION’S NAME
OR |
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3B. INDIVIDUAL’S |
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LAST NAME |
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FIRST NAME |
MIDDLE |
SUFFIX |
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3C. MAILING ADDRESS: |
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ADDRESS: |
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CITY: |
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COUNTRY: |
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4. ADDITIONAL JUDGMENT CREDITORS FULL LEGAL NAME |
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4A. ORGANIZATION’S NAME |
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OR |
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4B. INDIVIDUAL’S |
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LAST NAME |
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FIRST NAME |
MIDDLE |
SUFFIX |
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4C. MAILING ADDRESS: |
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ADDRESS: |
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CITY: |
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STATE: |
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COUNTRY: |
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5. COURT IN WHICH JUDGMENT WAS RENDERED |
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6. DATE OF JUDGMENT |
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7. ORIGINAL JUDGMENT AMOUNT |
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8. AMOUNT DUE |
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9. PERSONAL PROPERTY ON WHICH LIEN IS PLACED |
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10. JUDGMENT CREDITOR SIGNATURE: |
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11. DATE: |
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FORM UJPERS-1-1.0 |
PAGE 2 OF 2 |
Rev. 7/2010 |