Financing Statement Change Form - Commonwealth Of Pennsylvania
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1PARTIES
FINANCING STATEMENT CHANGE
Debtor name (last name first if individual) and mailing address:
Uniform Commercial Code Form UCC-3
IMPORTANT - Please read instructions before completing
Filing No. (stamped by filing officer):Date, Time, Filing Office (stamped by filing officer):
Print this form
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5
Debtor name (last name first if individual) and mailing address:
This Financing Statement Change is presented for filing pursuant to the Uniform
Commercial Code, and is to be filed with the (check applicable box):
o
Secretary of the Commonwealth.
o
Prothonotary of ___________________________________________County.
o
Real Estate Records of _____________________________________County.
7
Number of Additional Sheets (if any):
8
Optional Special Identification (Max. 10 characters):
ORIGINAL FINANCING STATEMENT BEING CHANGED
1a
This Financing Statement Change relates to original Financing Statement
Debtor name (last name first if individual) and mailing address:
No.____________________________ filed with the:
o
Secretary of the Commonwealth on (date) _________________________________.
o
Prothonotary of _________________________County on (date)_________________.
o
Real Estate Records of ____________________County on (date) _______________.
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DESCRIPTION OF FINANCING STATEMENT CHANGE
o
Continuation - The original Financing Statement identified above is still effective.
o
Termination - The Secured Party of Record no longer claims a security interest
1b
under original Financing Statement identified above.
o
Secured Party(ies) of Record name(s) (last name first if
Release - The Secured Party of Record has released the collateral described in
individual) address for security interest information:
Block 11 from the collateral covered by the Financing Statement identified above.
o
Assignment - The Secured Party of Record has assigned to the Assignee, whose
address are contained in block 11, rights in the collateral described in block 11,
under the original Financing Statement identified above.
o
Amendment - The original Financing Statement identified above is amended as
set forth in Block 11 (signatures of Debtor and Secured Party of Record are
required).
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10
Special Types of Parties (check if applicable):
Description of collateral released, rights assigned, Assignee (name and address)
o
The terms “Debtor” and “Secured Party” mean “Lessee”
or Amendment (as indicated in block 10):
and “Lessor”, respectively.
o
The terms “Debtor” and “Secured Party” mean “Consignee”
and “Consignor”, respectively.
o
Debtor is a Transmitting Utility.
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SIGNATURE(S)
Debtor Signature(s) (only if Amendment):
11
RETURN RECEIPT TO:
Secured Party Signature(s):
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Approved by the Secretary of the Commonwealth of Pennsylvania
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