Form Ucc1 - Ucc1 Financing Statement , Form Ucc1ad - Financing Statement Addendum - 2001
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4For your convenience, this form has been
Mississippi - UCC1 FINANCING STATEMENT (IN LIEU)
designed to be completed online. The
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
information typed on the first page will
A. NAME & PHONE OF CONTACT AT FILER [optional]
automatically update to the other pages.
Please be sure all pertinent information is
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
completed before printing. Once the form
is completed, select 'Print' to print the form
and mail it. Selecting 'Reset' will clear the
entire form.
Print
Reset
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THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
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
1D. COUNTY #
1c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
ADD'L INFO RE
1e. TYPE OF ORGANIZATION
1f. JURISDICTION OF ORGANIZATION
1g. ORGANIZATIONAL ID #, if any
1d. TAX ID #:
SSN OR EIN
ORGANIZATION
DEBTOR
NONE
DEBTOR'S
2. ADDITIONAL
EXACT FULL LEGAL NAME
- insert only one debtor name (2a or 2b) - do not abbreviate or combine names
2a. ORGANIZATION'S NAME
OR
FIRST NAME
MIDDLE NAME
SUFFIX
2b. INDIVIDUAL'S LAST NAME
2D. COUNTY #
POSTAL CODE
2c. MAILING ADDRESS
CITY
STATE
2d. TAX ID #:
SSN OR EIN
ADD'L INFO RE
2e. TYPE OF ORGANIZATION
2f. JURISDICTION OF ORGANIZATION
2g. ORGANIZATIONAL ID #, if any
ORGANIZATION
DEBTOR
NONE
SECURED PARTY'S
3.
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
THE FINANCING STATEMENT IS AN "IN LIEU OF CONTINUATION" FOR THE FOLLOWING STATEMENTS, EACH
OF WHICH SHALL REMAIN EFFECTIVE:
File Date
File Number
Original Filing Office
File Date
File Number
Original Filing Office
See Addendum #16 for collateral
5.
ALTERNATIVE DESIGNATION [if applicable]:
LESSEE/LESSOR
CONSIGNEE/CONSIGNOR
BAILEE/BAILOR
SELLER/BUYER
AG. LIEN
NON-UCC FILING
6.
This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL
7.
Check to REQUEST SEARCH REPORT(S) on Debtor(s)
All Debtors
Debtor 1
Debtor 2
ESTATE RECORDS.
Attach Addendum
[if applicable]
[ADDITIONAL FEE]
[optional]
OPTIONAL FILER REFERENCE DATA
8.
Filing Office:
FILING OFFICE COPY — MISSISSIPPI UCC FINANCING STATEMENT (FORM UCC1) (REV. 10/01)
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