(a) A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in section 9-516(b):
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS
A. NAME & PHONE OF CONTACT AT FILER (optional)
________________________________
B. E-MAIL CONTACT AT FILER (optional)
________________________________
C. SEND ACKNOWLEDGMENT TO: (Name and Address)
________________________________
THE ABOVE SPACE IS FOR
FILING OFFICE USE ONLY
1. DEBTOR'S NAME - provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
| 1a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR | |
| 1b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) THAT ARE | |
| PART OF THE NAME OF THIS DEBTOR | SUFFIX |
| ________________________________ | _____________ |
| 1c. MAILING ADDRESS | |
| ________________________________________ |
| CITY | STATE | POSTAL CODE | COUNTRY |
| __________ | __________ | __________ | __________ |
2. DEBTOR'S NAME - provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
| 2a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 2b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) THAT ARE | |
| PART OF THE NAME OF THIS DEBTOR | SUFFIX |
| ________________________________ | _____________ |
| 2c. MAILING ADDRESS | |
| ________________________________________ |
| CITY | STATE | POSTAL CODE | COUNTRY |
| __________ | __________ | __________ | __________ |
3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY) - provide only one Secured Party name (3a or 3b)
| 3a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 3b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) | SUFFIX |
| ________________________________ | _____________ |
| 3c. MAILING ADDRESS | |
| ________________________________________ |
| CITY | STATE | POSTAL CODE | COUNTRY |
| __________ | __________ | __________ | __________ |
4. COLLATERAL: This financing statement covers the following collateral:
________________________________
5. Check only if applicable and check only one box:
| Collateral is | ____ held in a Trust (see Instructions) |
| ____ being administered by a Decedent's Personal | |
| Representative. |
6a. Check only if applicable and check only one box:
____ Public-Finance Transaction
____ Manufactured-Home Transaction
____ A Debtor is a Transmitting Utility
6b. Check only if applicable and check only one box:
____ Agricultural Lien ____ Non-UCC Filing
7. ALTERNATIVE DESIGNATION (if applicable): ____ Lessee/Lessor ____ Consignee/Consignor ____ Seller/Buyer ____ Bailee/Bailor ____ Licensee/Licensor
8. OPTIONAL FILER REFERENCE DATA
________________________________________
[UCC FINANCING STATEMENT (Form UCC1)]
UCC FINANCING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS
9. NAME OF FIRST DEBTOR (same as item 1a or 1b on Financing Statement)
| 9a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR | |
| 9b. INDIVIDUAL'S SURNAME | |
| ________________________________ | |
| FIRST PERSONAL NAME | |
| ________________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) | SUFFIX |
| ________________________________ | _____________ |
THE ABOVE SPACE IS FOR
FILING OFFICE USE ONLY
10. ADDITIONAL DEBTOR'S NAME - provide only one Debtor name (10a or 10b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
| 10a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 10b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) THAT ARE | |
| PART OF THE NAME OF THIS DEBTOR | SUFFIX |
| ________________________________ | _____________ |
| 10c. MAILING ADDRESS | |
| ________________________________ |
| CITY | STATE | POSTAL CODE | COUNTRY |
| __________ | __________ | __________ | __________ |
11. ____ ADDITIONAL SECURED PARTY'S NAME or ____ ASSIGNOR SECURED PARTY'S NAME - provide only one name (11a or 11b)
| 11a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 11b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) | SUFFIX |
| ________________________________ | _____________ |
| 11c. MAILING ADDRESS | |
| ________________________________________ |
| CITY | STATE | POSTAL CODE | COUNTRY |
| __________ | __________ | __________ | __________ |
12. ADDITIONAL SPACE FOR ITEM 4 (Collateral)
________________________________
13. ____ This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS (if applicable)
14. This FINANCING STATEMENT: _____ covers timber to be cut _____ covers as-extracted collateral _____ is filed as a fixture filing
15. Name and address of a RECORD OWNER of real estate described in item 16 (if Debtor does not have a record interest):
________________________________
16. Description of real estate:
________________________________
17. MISCELLANEOUS:
________________________________
[UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad)]
(b) A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in section 9-516(b):
UCC FINANCING STATEMENT AMENDMENT
FOLLOW INSTRUCTIONS
A. NAME & PHONE OF CONTACT AT FILER (optional)
________________________________
B. E-MAIL CONTACT AT FILER (optional)
________________________________
C. SEND ACKNOWLEDGMENT TO: (Name and Address)
________________________________
THE ABOVE SPACE IS FOR
FILING OFFICE USE ONLY
1a. INITIAL FINANCING STATEMENT FILE NUMBER
________________________________
1b. ____ This FINANCING STATEMENT AMENDMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS.
Filer: attach Amendment Addendum (Form UCC3Ad) and provide Debtor's name in item 13.
2. ____ TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to the security interest(s) of Secured Party authorizing this Termination Statement
3. ____ ASSIGNMENT (full or partial): Provide name of Assignee in item 7a or 7b, and address of Assignee in item 7c and name of Assignor in item 9. For partial assignment, complete items 7 and 9 and also indicate affected collateral in item 8
4. ____ CONTINUATION: Effectiveness of the Financing Statement identified above with respect to the security interest(s) of Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law
5. ____ PARTY INFORMATION CHANGE:
Check one of these two boxes:
This Change affects ____ Debtor or ____ Secured Party of record.
AND
Check one of these three boxes to:
____ CHANGE name and/or address: Complete item 6a or 6b, and item 7a or 7b and item 7c.
____ ADD name: Complete item 7a or 7b, and item 7c.
____ DELETE name: Give record name to be deleted in item 6a or 6b.
6. CURRENT RECORD INFORMATION: Complete for Party Information Change - provide only one name (6a or 6b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
| 6a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 6b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) | SUFFIX |
| ________________________________ | _____________ |
7. CHANGED OR ADDED INFORMATION: Complete for Assignment or Party Information Change - provide only one name (7a or 7b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
| 7a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 7b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) THAT ARE | |
| PART OF THE NAME OF THIS DEBTOR | SUFFIX |
| ________________________________ | _____________ |
| 7c. MAILING ADDRESS | |
| ________________________________________ |
| CITY | STATE | POSTAL CODE | COUNTRY |
| __________ | __________ | __________ | __________ |
8. ____ COLLATERAL CHANGE:
Also check one of these four boxes:
____ ADD collateral ____ DELETE collateral ____ RESTATE covered collateral ____ ASSIGN collateral
Indicate collateral:
9. NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT - provide only one name (9a or 9b) (name of Assignor, if this is an Assignment)
If this is an Amendment authorized by a DEBTOR, check here ____ and provide name of authorizing Debtor
| 9a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 9b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) | SUFFIX |
| ________________________________ | _____________ |
10. OPTIONAL FILER REFERENCE DATA
________________________________
[UCC FINANCING STATEMENT AMENDMENT (Form UCC3)]
UCC FINANCING STATEMENT AMENDMENT ADDENDUM
FOLLOW INSTRUCTIONS
11. INITIAL FINANCING STATEMENT FILE NUMBER (same as item 1a on Amendment form)
________________________________
12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on Amendment form)
| 12a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 12b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) | SUFFIX |
| ________________________________ | _____________ |
THE ABOVE SPACE IS FOR
FILING OFFICE USE ONLY
13. Name of DEBTOR on related financing statement (Name of a current Debtor of record required for indexing purposes only in some filing offices - see Instruction for item 13 - insert only one Debtor name (13a or 13b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
| 13a. ORGANIZATION'S NAME | |
| ________________________________ | |
| OR |
| 13b. INDIVIDUAL'S SURNAME | FIRST PERSONAL NAME |
| ________________________________ | ____________________________ |
| ADDITIONAL NAME(S)/INITIAL(S) | SUFFIX |
| ________________________________ | _____________ |
14. ADDITIONAL SPACE FOR ITEM 8 (Collateral)
________________________________
15. This FINANCING STATEMENT AMENDMENT: ____ covers timber to be cut ____ covers as-extracted collateral ____ is filed as a fixture filing
16. Name and address of a RECORD OWNER of real estate described in item 17 (if Debtor does not have a record interest):
________________________________
17. Description of real estate
________________________________
18. MISCELLANEOUS:
________________________________
[UCC FINANCING STATEMENT AMENDMENT ADDENDUM (Form UCC3Ad)]