Fillable Information Request Form Ucc11 printable pdf download

INFORMATION REQUEST

FOLLOW INSTRUCTIONS

A. NAME & PHONE OF CONTACT AT FILER (optional)

FILING OFFICE ACCT #

B. E-MAIL CONTACT AT FILER (optional)

C. RETURN TO: (Name and Address)

Reset

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

DEBTOR'S

NAME to be searched:

Provide only one Debtor name (1a or 1b) (use exact full name; do not omit, modify or abbreviate any part of the Debtor's name)

1a. ORGANIZATION'S NAME

1b. INDIVIDUAL'S SURNAME

FIRST PERSONAL NAME

SUFFIX

ADDITIONAL NAME(S)/INITIAL(S)

INFORMATION OPTIONS

relating to UCC filings and other notices on file in the filing office that include the Debtor name identified in item 1:

LISTING RELATING TO DEBTOR AT SPECIFIED CITY AND STATE ONLY

—

2a.

Filing office requested to furnish a search report listing all financing statements, related records,

and other notices on file in filing office that include the Debtor's name identified in item 1 and show that Debtor's address in the city, state, and country indicated here:

CITY

STATE

COUNTRY

INFORMATION REQUEST RESPONSE WITH FULL COPIES (CERTIFIED)

—

2b.

Filing office requested to furnish a search report listing all financing statements, related records, and

other notices, showing date and time of filing and name and address of each Secured Party named therein, and also furnish an exact CERTIFIED COPY of ALL reported records (including all attachments)

INFORMATION REQUEST RESPONSE WITHOUT COPIES

—

2c.

Filing office requested to furnish a search report (as described in 2b) listing all reported records, but to furnish NO

COPIES of reported records

INFORMATION REQUEST RESPONSE WITH PARTIAL COPIES (CERTIFIED)

—

2d.

Filing office requested to furnish a search report (as described in 2b) and also to furnish an

exact CERTIFIED COPY of the FIRST PAGE ONLY of all reported records

SPECIFIED COPIES ONLY

—

Filing office requested to furnish an exact copy of each page of the financing statements, related records, and other notices (including all attachments) that are identified

below by record number. Certain filing offices require additional identifying information — please complete if required

CERTIFIED COPY REQUEST

—

Filing office requested to furnish CERTIFIED copies per request indicated in this item 3

Record Number

Date Record Filed

Type of Record and Additional Identifying Information

(if required)

LISTING RELATING TO SECURED PARTY

—

Filing office requested to furnish a search report listing all financing statements, related records, and other notices (regardless of Debtor

name) on file in filing office that include the Secured Party's name identified in item 4a or 4b. If a specified city, state, and country are being requested (optional), show that Secured Party's address in item 4c

4a. ORGANIZATION'S NAME

O R

4b. INDIVIDUAL'S SURNAME

FIRST PERSONAL NAME

ADDITIONAL NAME(S)/INITIAL(S)

SUFFIX

4c. CITY

STATE

COUNTRY

5. DELIVERY INSTRUCTIONS

(request will be filled by mail sent to address shown in item C unless otherwise instructed here):

(

)

FAX Delivery —

Filing office requested to fax results of this Information Request to fax number indicated here:

Pick Up

Other

Specify desired method here (if available from this office); provide delivery information (e.g., delivery service's name, addressee's account # with delivery service, addressee's phone #, etc.)

Office of the Secretary of State of Texas

FILING OFFICE COPY (1) — INFORMATION REQUEST (Form UCC11) (Texas) (Rev. 07/19/12)