Ucc Financing Statement
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1IN LIEU OF CONTINUATION
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
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
MIDDLE NAME
SUFFIX
FIRST NAME
1c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
ADD'L INFO RE
1e. TYPE OF ORGANIZATION
1f. JURISDICTION OF ORGANIZATION
1g. ORGANIZATIONAL ID #, if any
1 d. TAX ID# (Organizations)
ORGANIZATION
DO NOT USE
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
MIDDLE NAME
2b. INDIVIDUAL'S LAST NAME
FIRST NAME
SUFFIX
2c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
2e. TYPE OF ORGANIZATION
2f. JURISDICTION OF ORGANIZATION
2g. ORGANIZATIONAL ID #, if any
2d. TAX ID# (Organizations)
ADD'L INFO RE
ORGANIZATION
DO NOT USE
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
CITY
STATE
COUNTRY
3c. MAILING ADDRESS
POSTAL CODE
4.
:
This FINANCING STATEMENT covers the following collateral
THIS FINANCING STATEMENT IS AN "IN LIEU OF CONTINUATION" FOR THE FOLLOWING STATEMENT OF WHICH SHALL REMAIN EFFECTIVE:
FILE DATE:
FILE NUMBER:
ORIGINAL FILING OFFICE:
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
REQUEST SEARCH REPORT(S) ON UCC-11 FORM
NOT USED
ESTATE RECORDS.
Attach Addendum [if applicable]
8.
OPTIONAL FILER REFERENCE DATA
SOUTH CAROLINA SECRETARY OF STATE'S OFFICE, 1205 Pendleton Street Suite 525 Columbia, SC 29201
(03/01/2011)
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