INFORMATION REQUEST Type or Print This Form
FOLLOW INSTRUCTION PAGE CAREFULLY
A. NAME & PHONE OF CONTACT
B. ACCOUNT #
C. RETURN TO: (Name & Address)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
___________________________________________
D. SEARCH TYPE: EXPEDITED (Additional Fee) REGULAR
E. DELIVERY INSTRUCTIONS: REGULAR MAIL PICK UP EXPRESS MAIL (See Below)
EXPRESS MAIL NAME EXPRESS ACCOUNT # ______________________________________
1. DEBTOR NAME TO BE SEARCHED Insert only one debtor name (1a or 1b) Do not abbreviate or combine names
OR
1a. ORGANIZATION’S NAME
1b. INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME
ADDITIONAL NAME/INITIAL
SUFFIX
2. DOCUMENT OPTIONS:
All (Includes lapsed financing statements) Unlapsed
3. SEARCH OPTIONS:
3a. SEARCH CERTIFICATE Furnish a listing of financing statements and tax liens. No copies are provided.
3b. SEARCH CERTIFICATE and COPIES Furnish a listing and copies of financing statements and tax liens.
3c. FACE COPIES Furnish copies of the FIRST PAGE ONLY of financing statements and tax liens.
3d. SPECIFIC COPIES Furnish copies of each page of the financing statements, identified below by
document file number. RELATED SUBSEQUENT DOCUMENTS
FILE NUMBER
DATE FILED
FILE NUMBER
DATE FILED
3e.
LISTING AND COPIES FOR SPECIFIC TIME PERIOD ONLY BEGINNING DATE _______________________________________________
ENDING DATE __________________________________________ INCLUDE RELATED DOCUMENTS OUTSIDE TIME PERIOD
3f.
LISTING AND COPIES FOR SPECIFIC CITY Identify the city to be searched:
3g.
___________________________________________________________________________________________________________________
CERTIFIED SEAL Additional fee required.
FILING OFFICE COPY MICHIGAN INFORMATION REQUEST (FORM UCC11, REV. 05/10/17)
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INSTRUCTIONS FOR MICHIGAN INFORMATION REQUEST FORM UCC11
Please type or print this form. Be sure it is completely legible. Follow instructions completely. Carefully fill out this form;
mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give
legal advice. When the form is complete, send it with the required fee to the filing office.
A. NAME & PHONE OF CONTACT: Name and phone number for the contact person is required.
B. ACCOUNT NUMBER: If you have an established Michigan Uniform Commercial Code billing account number, enter the
number in this box.
C. RETURN TO (Name and Address): The name and address of requestor is required.
D. SEARCH TYPE, EXPEDITED OR REGULAR: Mark the appropriate box. Expedited search fees are an additional $25
per Debtor name. All fax search requests are processed as expedited and must include an account number. Regular
fees are $6 per Debtor name and must be submitted in person or by mail. Copy fees are $2 per page.
E. DELIVERY INSTRUCTIONS, REGULAR MAIL, PICK UP or EXPRESS MAIL: Mark the appropriate box. Expedited
counter pick-ups are available after 3:00 p.m. For express mail, remember to give the express mail company name and
account number. If no box is checked, the search will be returned by regular mail.
1. DEBTOR NAME: Enter only one Debtor name in item 1. Enter Debtor’s correct name. Do not abbreviate. The Debtor
can be an organization or an individual, but not both. If you want to search both an organization and an individual who is
a principal, two search requests are needed.
1a. ORGANIZATION’S NAME: “Organization’s Name” means the name of an entity that is not a natural person.
A partnership is an organization; a sole proprietorship is not an organization, even if it does business under a trade
name. If the Debtor is a partnership, enter exact full legal name of the partnership; you do not need to enter names of
partners as additional Debtors. If Debtor is a registered organization, like a corporation, limited partnership, or limited
liability company, look at the Debtor’s currently filed public organic records to determine the correct name.
1b. INDIVIDUAL’S NAME: “Individual’s Name” means a natural person including a sole proprietorship, whether or not
operating under a trade name. An individual debtor name includes the name of a decedent where collateral is being
administered by a personal representative of the decedent. Individual debtor name does not include the name of an
entity, even if it contains, as part of the entity’s name, the name of an individual. Do not use prefixes like Mr., Mrs., or
Ms. Use suffix box only for titles of lineage like Jr., Sr., or III and not for other suffixes like M.D. Use a married woman’s
personal name like Mary Smith, not Mrs. John Smith. Enter individual Debtor’s family name or last name in the
Surname box, first given name in the First Personal Name box and all additional given names in the Additional
Name/Initial box. If a Debtor’s name consists of only a single word, enter the word in the Surname box and leave other
name boxes blank.
For both ORGANIZATION and INDIVIDUAL Debtors: Do not use trade names like DBA, AKA, FKA or the Division name
in place of or combined with Debtor’s correct name. For example, do not use “Simpson Motor Inc. DBA Cornelia Car
City” or “John Smith DBA Smith’s Coffee Shop”. Search results from such requests may not give financing statements
on file that use the correct name of the Debtor.
2. DOCUMENT OPTIONS: Check either the All or Unlapsed box. When the option “All” is marked, lapsed financing
statements are given for one year after the date the financing statement would have lapsed. When the option
“Unlapsed” is marked, only unlapsed financing statements are reported.
3. SEARCH OPTIONS: The Michigan Department of State UCC Office offers all the additional services listed in item 3.
Check the appropriate option or options. Include additional information, if applicable. To request an update search,
state “current” or “certification date” on the second line after box 3e. Check the second box after 3e to include copies of
related documents outside the time range specified. For example, if this box is checked, for an amendment financing
statement filed within the time period specified, the related initial financing statement is included in the search results.
For certified seals, typically used in court proceedings, an additional fee is charged.
4. Submit the completed UCC11 by Regular Mail: In Person or Express Mail:
Michigan Department of State Michigan Department of State
Uniform Commercial Code Section Uniform Commercial Code Section
PO Box 30197 7064 Crowner Drive
Lansing, MI 48909-7697 Dimondale, MI 48821