Oregon Revised Statutes Procedure in Civil Proceedings § 18.170

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LIEN RECORD ABSTRACT

The undersigned states:

A.

Creditor/Prevailing Party Information:

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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. __________.

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2. The creditor's attorney's name is

__________________________________________

Attorney's Address is:

__________________________________________

Attorney's Phone No. is:  ________________

B.

Debtor/Losing Party Information:

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1. The debtor/losing party is:

__________________________________________

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2. Debtor's address (if known):

__________________________________________

__________________________________________

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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):

__________________________________________

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4. The final four digits of the debtor's driver license no. and state of issuance for the license (if known):

__________________________________________

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5. Name of debtor's attorney (if known):

__________________________________________

C.

Judgment Information:

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1. The amount of the judgment is:

__________________________________________

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2. The amount of the costs is:

__________________________________________

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3. The amount of attorney fees, if any is:

__________________________________________

D.

(Check appropriate box):

___

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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:  _________________________

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