Form Ucc1 - Ucc1 Financing Statement , Form Ucc1ad - Financing Statement Addendum - 2001 Page 2
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4Mississippi - UCC1 FINANCING STATEMENT ADDENDUM (In Lieu)
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
DEBTOR
9. NAME OF FIRST
(1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME
OR
MIDDLE NAME,SUFFIX
9b. INDIVIDUAL'S LAST NAME
FIRST NAME
10. MISCELLANEOUS:
ADDITIONAL "IN LIEU OF CONTINUATION" STATEMENTS:
File Date
File Number
Original Filing Office
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
DEBTOR'S
11. ADDITIONAL
EXACT FULL LEGAL NAME
- insert only one name (11a or 11b) - do not abbreviate or combine names
11a. ORGANIZATION'S NAME
OR
11b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
11D. COUNTY #
11c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
11e. TYPE OF ORGANIZATION
11f. JURISDICTION OF ORGANIZATION
11g. ORGANIZATIONAL ID #, if any
11d. TAX ID #:
SSN OR EIN
ADD'L INFO RE
ORGANIZATION
DEBTOR
NONE
SECURED PARTY'S
ASSIGNOR S/P'S
12.
ADDITIONAL
NAME
or
- insert only one name (12a or 12b)
12a. ORGANIZATION'S NAME
OR
12b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
STATE
POSTAL CODE
COUNTRY
12c. MAILING ADDRESS
CITY
13.
16.
timber to be cut or
This FINANCING STATEMENT covers
as-extracted
Additional collateral description:
collateral, or is filed as a
fixture filing.
14.
Description of real estate:
15.
Name and address of a RECORD OWNER of above-described real estate
(if Debtor does not have a record interest):
17.
Check only if applicable and check only one box.
Debtor is a
Trust or
Trustee acting with respect to property held in trust or
Decedent's Estate
18.
Check only if applicable and check only one box.
Debtor is a TRANSMITTING UTILITY
Filed in connection with a Manufactured-Home Transaction — effective 30 years
Filed in connection with a Public-Finance Transaction — effective 30 years
FILING OFFICE COPY — Mississippi UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 10/01)
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