FSA-2360 Report of lien search

Form Approved - OMB No. 0560-XXXX
Position 1

This form is available electronically.
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-2360
(Proposal 6)

REPORT OF LIEN SEARCH
(See Page 3 for Privacy Act and Public Burden Statements)

PART A - APPLICANT INFORMATION
1A. Applicant's Full Legal Name

2. Address (Including Zip Code)

1B. Known as:

3. County of Residence

4. Records Searched for (County or State)

5. Types of Lien and Period of Search (Check Appropriate Boxes):
A. Financing Statement (or other instruments filed as such)
years

F. Other (Specify)

B. Chattel Mortgages
Bills of Sale securing debt)

G. State Tax liens

years

years (Deeds of Trust,

C. Crop Mortgages

H. Federal Tax Liens (Eleven years and one month)

years

D. Conditional Sale Contract (Title retained)

years

E. Personal Property Tax

years

I. Attachments

years

J. Judgments

years

K. Executions

years

years

6. Name of Agency Official :

7. Date:

PART B - LIEN SEARCH
1. COMPLETED BY SEARCHER
A.
Type of Lien

B.
Date Filed

C.
File/Book
Page No.

D.
Amount

E.
Due Date

F.
To Whom Given

G.
Description of Property

$

$

$

$

$

$

I have made the searches checked above and have listed all liens, or instruments not charged, or terminated, affecting the personal
property or fixtures of the above-named person.
2. Name

3. Title

4. Signature

5. Date

6. Hour

AM

PM

FSA-2360 (Proposal 6)
7.

Page 2 of 3

CONTINUATION OF LIEN SEARCH (from the date and hour given in Part
A.
Type of Len

B.
Date Filed

C.
File/Book
Page No.

D.
Amount

E.
Due Date

B, Items 5 and 6, to date and hour given below)
F.
To Whom Given

G.
Description of Property

$
$

$
$
$

$

I have made the searches checked above and have listed all liens, or instruments not charged, or terminated, affecting the
personal property or fixtures of the above-named person.
8. Name

9. Title

10. Signature

11. Date

12. Hour
AM

13. CONTINUATION
A.
Type of Lien

PM

OF LIEN SEARCH (from the date and hour given in Part B, Items 11 and 12, to date and hour given below)
B.
Date Filed

C.
File/Book
Page No.

D.
Amount

E.
Due Date

F.
To Whom Given

G.
Description of Property

$
$
$
$
$
$

I have made the searches checked above and have listed all liens, or instruments not charged, or terminated, affecting
the personal property or fixtures of the above-named person.
14. Name

15. Title

16. Signature

17. Date

18. Hour
AM

PM

FSA-2360 (Proposal 6)

Page 3 of 3

19. Remarks

20. For FSA Use Only. Return complete report and any lien or other instrument submitted herewith to the following address:

NOTE:

The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated
Farm and Rural Development Act, as amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information
requested on its application forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your
loan, and conduct statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies, the Internal Revenue Service, the
Department of Justice or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of
Labor, the United States Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to
interested parties under the Freedom of Information Act (FOIA), to financial consultants, advisors, lending institutions, packagers, agents, and private or
commercial credit sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the Department of
Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or Congressional staff members, or to
courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to disclose certain items of information requested, including
your Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of an application or its rejection.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-XXXX. The time required to complete this
information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA
OFFICE.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program and activities on the basis of race, color, national origin, age, disability, and where
applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s
income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for
communication of program information ( Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint
of Discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202)
720-6382 (TDD). USDA is an equal opportunity provider and employer.