INFORMATION REQUEST
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A.
NAME & PHONE OF CONTACT
FILING OFFICE ACCT #
B.
RETURN TO: (Name and Address)
THIS SPACE FOR FILING OFFICER USE ONLY
1. DEBTOR NAME
to which this request relates – insert only one debtor name (1a or 1b) – do not abbreviate or combine names
1a. ORGANIZATION NAME
1b. INDIVIDUAL LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
2. INFORMATION OPTIONS
RELATING TO UCC FILINGS AND OTHER NOTICES FILED IN FILING OFFICE THAT INCLUDE AS A DEBTOR THE NAME IDENTIFIED IN ITEM 1
For 2a and 2b, mark this box to request a Search that is COMPLETE to include lapsed and unlapsed filings. UNLESS MARKED, SEARCH MAY BE INCOMPLETE.
2a.
SEARCH RESPONSE with copies of ALL records found.
Please CERTIFY all copies (additional $5.00 fee per record).
2b.
SEARCH RESPONSE only.
2c.
COPIES ONLY. Please complete the information below, as appropriate. For UCC3 records, include the type of UCC3 and corresponding filing date.
File Number
# of copies
# of Certified copies
File Date
Filing Type – Financing Statement, Cont., Term., Assign.,
(add’l fee applies)
(use for UCC3 only)
Amend.
3. CALIFORNIA SECRETARY OF STATE’S OFFICE OFFERS THESE ADDITIONAL SEARCHING OPTIONS - (Please see instructions)
:
SEARCH TO REFLECT – Please run the search after the filing document accompanying this request has been filed.
3a
.
SEARCH LIMITED TO THE FOLLOWING ADDRESS
3b
.
: _____________________________ _______________________________________________________________
SEARCH LIMITED FROM THIS DATE
3c
.
:
DELIVERY INSTRUCTIONS
4.
Pick Up (Only if request was originally delivered to our Public Counter)
4a.
Other: ____________________________________________________________________________________________________________
4b.
Specify desired method; Completed prepaid airbill and packaging must accompany this request, if applicable.
________________________________________________________________________________________________________________________________________
_
FILING OFFICER COPY – NATIONAL INFORMATION REQUEST (FORM UCC 11)) (Rev5/09/01)
CA Secretary of State (REV. 9/1/02)