Form Uo-1-1.0 - Ucc-1 Financing Statement - Connecticut Secretary Of State - 2010 Page 2
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4ADDITIONAL INFORMATION REORGANIZATION DEBTOR
2D. TYPE OF ORGANIZATION: 2E. JURISDICTION OF ORGANIZATION: 2F. ORGANIZATIONAL ID # OPTIONAL
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
SUFFIX
3C. MAILING ADDRESS:
ADDRESS:
CITY:
STATE:
ZIP:
COUNTRY:
4. THIS FINANCING STATEMENT COVERS THE FOLLOWING COLLATERAL:
5. ALTERNATIVE DESIGNATION:
LESSEE/LESSOR
CONSIGNEE/CONSIGNOR
BAILEE/BAILOR
SELLER/BUYER
6. OPTIONAL FILER REFERENCE DATA:
FORM UO-1-1.0
PAGE 2 OF 2
Rev. 7/2010
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