Form Ucc1 - Ucc Financing Statement
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1
2UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS
A. NAME & PHONE OF CONTACT AT FILER (optional)
B. E-MAIL CONTACT AT FILER (optional)
C. EMAIL ACKNOWLEDGMENT TO: (Email Address)
Print
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THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
DEBTOR'S
1.
NAME:
Provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor’s name); if any part of the Individual Debtor’s
name will not fit in line 1b, leave all of item 1 blank, check here
and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)
1a. ORGANIZATION'S NAME
OR
ADDITIONAL NAME(S)/INITIAL(S)
1b. INDIVIDUAL'S SURNAME
FIRST PERSONAL NAME
SUFFIX
1c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
DEBTOR'S
2.
NAME
: Provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor’s name); if any part of the Individual Debtor’s
name will not fit in line 2b, leave all of item 2 blank, check here
and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)
2a. ORGANIZATION'S NAME
OR
2b. INDIVIDUAL'S SURNAME
FIRST PERSONAL NAME
ADDITIONAL NAME(S)/INITIAL(S)
SUFFIX
2c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
SECURED PARTY'S
3.
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 UCC1Ad, item 17 and Instructions)
being administered by a Decedent’s Personal Representative
6a.
6b.
Check only if applicable and check only one box:
Check only if applicable and check only one box:
Public-Finance Transaction
Manufactured-Home Transaction
A Debtor is a Transmitting Utility
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:
I
FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11)
Rev. 4/21/16
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