State Of Louisiana Uniform Commercial Code - Financing Statement Ucc-1
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1
2STATE OF LOUISIANA
UNIFORM COMMERCIAL CODE - FINANCING STATEMENT
UCC-1
Important - Read Instructions before filing out form.
Follow instructions carefully.
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 (and Title of Lineage (e.g. Jr. Sr., III, if applicable)
First Name
Middle Name
1c Mailing Address
City
State
Postal Code
Country
1d Tax ID #: SSN or EIN
Add’l info re
1e Type of
1f Jurisdiction of
1g Organizational ID # if any
Organization
Organization
Organization
Debtor:
None
2. Additional debtor’s exact full legal name - insert only one debtor name (2a or 2b) - do not abbreviate or combine names.
2a Organization’s Name
OR
2b Individual’s Last Name (and Title of Lineage (e.g. Jr., Sr. III), if applicable)
First Name
Middle Name
2c Mailing Address
City
State
Postal Code
Country
2d Tax ID #: SSN or EIN
Add’l info re
2e Type of
2f Jurisdiction of
2g Organizational ID #, if any
Organization
Organization
Organization
Debtor:
None
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 (and Title of Lineage (e,g. Jr., Sr., III), if applicable
First Name
Middle Name
3c Mailing Address
City
State
Postal Code
Country
4. This FINANCING STATEMENT covers the following collateral:
5a Check if applicable and attach legal description of real property:
Fixture filing
As-extracted collateral
Standing timber constituting goods
The debtor(s) do not have an interest of record in the real property (Enter name of an owner of record in 5b)
5b Owner of real property (if other than named debtor)
6a Check only if applicable and check only one box
10. The space below is for Filing Office Use Only
Debtor is a Transmitting Utility. Filing is Effective Until Terminated
Filed in connection with a public finance transaction. Filing is effective
for 30 years
6b 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
7.
ALTERNATIVE DESIGNATION (If applicable):
LESSEE/LESSOR
CONSIGNEE/CONSIGNOR
BAILEE/BAILOR
G
SELLER/BUYER
AG. LIEN
NON-UCC-FILIN
8. Name and Phone Number to contact filer
9. Send Acknowledgment To: (Name and Address)
11.
CHECK TO REQUEST SEARCH REPORT(S) ON DEBTORS
(ADDITIONAL FEE REQUIRED)
ALL DEBTORS
DEBTOR1
DEBTOR2
LOUISIANA SECRETARY OF STATE 11/22/2010
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Parent category: Financial