Form Ucc1ad - Ucc Financing Statement Addendum
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1
2ADDENDUM
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS
9. NAME OF FIRST DEBTOR:
Same as line 1a or 1b on Financing Statement; if line 1b was left blank
because Individual Debtor name did not fit, check here
9a. ORGANIZATION'S NAME
OR
9b. INDIVIDUAL'S SURNAME
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FIRST PERSONAL NAME
ADDITIONAL NAME(S)/INITIAL(S)
SUFFIX
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
DEBTOR'S
10.
NAME
: Provide (10a or 10b) only one additional Debtor name or Debtor name that did not fit in line 1b or 2b of the Financing Statement (Form UCC1) (use exact, full name;
do not omit, modify, or abbreviate any part of the Debtor’s name) and enter the mailing address in line 10c
10a. ORGANIZATION'S NAME
OR
10b. INDIVIDUAL'S SURNAME
INDIVIDUAL’S FIRST PERSONAL NAME
INDIVIDUAL’S ADDITIONAL NAME(S)/INITIAL(S)
SUFFIX
10c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
SECURED PARTY'S
ASSIGNOR SECURED PARTY'S
11.
ADDITIONAL
NAME or
NAME:
Provide only one name (11a or 11b)
11a. ORGANIZATION'S NAME
OR
11b. INDIVIDUAL'S SURNAME
FIRST PERSONAL NAME
ADDITIONAL NAME(S)/INITIAL(S)
SUFFIX
STATE
POSTAL CODE
COUNTRY
11c. MAILING ADDRESS
CITY
12. ADDITIONAL SPACE FOR ITEM 4 (Collateral)
:
13.
14.
This FINANCING STATEMENT is to be filed [for record] (or recorded) in the
This FINANCING STATEMENT:
REAL ESTATE RECORDS (if applicable)
covers timber to be cut
covers as-extracted collateral
is filed as a fixture filing
15.
16.
Name and address of a RECORD OWNER of real estate described in item 16
Description of real estate:
(if Debtor does not have a record interest):
17. MISCELLANEOUS:
International Association of Commercial Administrators (IACA)
FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11)
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