STATE OF CONNECTICUT
UCC-1 FINANCING STATEMENT
MAILING ADDRESS:
COURIER ADDRESS:
Commercial Recording Division
Commercial Recording Division
Connecticut Secretary of the State
Connecticut Secretary of the State
P.O. BOX 150470
30 Trinity Street
Hartford, CT 06115-0470
Hartford, CT 06106
860-509-6002
860-509-6002
Follow Instructions Carefully
FEE: $50.00
Requesting Party
Cust ID ________________
(Space for filing office use only)
Name
Address
City
State
Zip
1.
DEBTOR’S EXACT FULL LEGAL NAME – insert only one debtor name (1a or 1b) – do not abbreviate or combine names
1a. ORGANIZATION’S NAME
OR
1b. INDIVIDUAL’S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
1c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
ADD’L INFO RE
1d. TYPE OF ORGANIZATION
1e. JURISDICTION OF ORGANIZATION
1f. ORGANIZATIONAL ID # OPTIONAL
ORGANIZATION
DEBTOR
2.
ADDITIONAL DEBTOR’S EXACT FULL LEGAL NAME – insert only one debtor name (2a or 2b) – do not abbreviate or combine names
2a. ORGANIZATION’S NAME
OR
2b. INDIVIDUAL’S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
2c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
ADD’L INFO RE
2d. TYPE OF ORGANIZATION
2e. JURISDICTION OF ORGANIZATION
2f. ORGANIZATIONAL ID # OPTIONAL
ORGANIZATION
DEBTOR
3.
SECURED PARTY’S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) – Insert only one secured party name (3a. or 3b.)
3a. ORGANIZATION’S NAME
OR
3b. INDIVIDUAL’S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
3c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
4. This FINANCING STATEMENT covers the following collateral:
5. ALTERNATIVE DESIGNATION (if applicable)
LESSEE/LESSOR
CONSIGNEE/CONSIGNOR
BAILEE/BAILOR
SELLER/BUYER
6. OPTIONAL FILER REFERENCE DATA
FILING OFFICE COPY – CONNECTICUT UCC FINANCING STATEMENT (FORM UCC1)
Revised 3/17/10