Ucc Financing Statement - State Of Tennessee Page 4
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4UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS
A. NAME & PHONE OF CONTACT AT FILER (Optional)
B. EMAIL 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 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
1b. INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME
ADDITIONAL NAME(S) INITIAL(S)
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 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
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:
Maximum principal indebtedness for Tennessee recording tax purposes is $
5. Check only if applicable and check only one box: Collateral is
held in Trust (see UCC1Ad, Item 17 and instructions)
being administered by a Decedent’s Personal Representative
6a. Check only if applicable and check only one box:
6b. 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:
NOTE: All information on this form is public record.
UCC FINANCING STATEMENT (TN FORM UCC1) (REV. 07/01/2013)
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