B. E-MAIL CONTACT AT FILER (optional)
FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
UCC FINANCING STATEMENTFOLLOW INSTRUCTIONS
A. NAME & PHONE OF CONTACT AT FILER (optional)
OR
1a. ORGANIZATION'S NAME
POSTAL CODE
CITY
1c. MAILING ADDRESS 1b. INDIVIDUAL'S SURNAME
STATE COUNTRY
8. OPTIONAL FILER REFERENCE DATA:
A Debtor is a Transmitting Utility
Manufactured-Home Transaction
Public-Finance Transaction
6a. Check only if applicable and check only one box:
7. ALTERNATIVE DESIGNATION (if applicable): Seller/Buyer Bailee/Bailor
Consignee/Consignor
Lessee/Lessor Agricultural Lien Non-UCC Filing
OR 3b. INDIVIDUAL'S SURNAME
FIRST PERSONAL NAME
POSTAL CODE
3c. MAILING ADDRESS CITYADDITIONAL NAME(S)/INITIAL(S)
STATESUFFIX
COUNTRY
3a. ORGANIZATION'S NAME 3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only one Secured Party name (3a or 3b)
4. COLLATERAL: This financing statement covers the following collateral:
C. SEND ACKNOWLEDGMENT TO: (Name and Address)
6b. Check only if applicable and check only one box:
Licensee/Licensor
Collateral is 5. Check only if applicable and check only one box:
held in a Trust (see UCC1Ad, item 17 and Instructions) being administered by a Decedent’s Personal Representative
OR
2a. ORGANIZATION'S NAME
POSTAL CODE
CITY
2c. MAILING ADDRESS 2b. INDIVIDUAL'S SURNAME
STATESUFFIX
COUNTRY
FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S)
SUFFIX
ADDITIONAL NAME(S)/INITIAL(S)
FIRST PERSONAL NAME
1.DEBTOR'S NAME: Provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, o\
r abbreviate any part of the Debtor’s name); if any par t of the Individual Debtor’s
name will not fit in line 1b, leave all of item 1 blank, check here and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)
2.DEBTOR'S NAME : Provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, o\
r abbreviate any part of the Debtor’s name); if any part of the Individual Debtor’s
name will not fit in line 2b, leave all of item 2 blank, check here and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad) International Association of Commercial Administrators (IACA)
Instructions for UCC Financing Statement (Form UCC1)
Please type or laser-print this form. Be sure it is completely legible.\
Read and follow all Instructions, especially Instruction 1; use of the correct namefor the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequen\
ces. If you have questions, consult your attorney. The filing office cannot give legal advice.
Send completed form and any attachments to the filing office, with the r\
equired fee.
ITEM INSTRUCTIONS
A and B. To assist filing offices that might wish to communicate with f\
iler, filer may provide information in item A and item B. These items are optional.
C. Complete item C if filer desires an acknowledgment sent to them. If fil\
ing in a filing office that returns an acknowledgment copy furnished by filer,
present simultaneously with this form the Acknowledgment Copy or a carbo\
n or other copy of this form for use as an acknowledgment copy.
1. Debtor’s name. Carefully review applicable statutory guidance about providing the de\
btor’s name. Enter
only one Debtor name in item 1 -- either
an organization's name (1a) or an individual’s name (1b). If any part of the Individual Debtor’\
s name will not fit in line 1b, check the box in item 1,
leave all of item 1 blank, check the box in item 9 of the Financing Stat\
ement Addendum (Form UCC1Ad) and enter the Individual D ebtor name in
item 10 of the Financing Statement Addendum (Form UCC1Ad). Enter Debt\
or’s
correct name. Do not abbreviate words that are not already
abbreviated in the Debtor’s name. If a portion of the Debtor’s na\
me consists of only an initial or an abbreviation rather than a full word, enter only
the abbreviation or the initial. If the collateral is held in a trust a\
nd the Debtor name is the name of the trust, enter trust name in the Organization’s
Name box in item 1a.
1a.
Organization Debtor Name. “Organization Name” means the name of an entity that is not a n\
atural person. A sole proprietorship is not an
organization, even if the individual proprietor does business under a tr\
ade name. If Debtor is a registered organization (e.g., corporation, limited
partnership, limited liability company), it is advisable to examine Deb\
tor’s current filed public organic records to determine Debtor's correct name.
Trade name is insufficient. If a corporate ending (e.g., corporation, \
limited partnership, limited liability company) is part of the Debtor’s name, it must
be included. Do not use words that are not part of the Debtor’s name\
.
1b.
Individual Debtor Name. “Individual Name” means the name of a natural person; this incl\
udes the name of an individual doing bu siness as a sole
proprietorship, whether or not operating under a trade name. The term i\
ncludes the name of a decedent where collateral is being administered by
a personal representative of the decedent. The term does not include th\
e name of an entity, even if it contains, as part of the entity’s name, the
name of an individual. Prefixes (e.g., Mr., Mrs., Ms.) and titles (e\
.g., M.D.) are generally not part of an individual name. Indications of lineage (e.g.,
Jr., Sr., III) generally are not part of the individual’s name, but \
may be entered in the Suffix box. Enter individual Debtor’s surname (family name)
in Individual’s Surname box, first personal name in First Personal Na\
me box, and all additional names in Additional Name(s)/Initial(s) box.
If a Debtor’s name consists of only a single word, enter that word in\
Individual’s Surname box and leave other boxes blank.
For both
organization and individual Debtors. Do not use Debtor’s trade name, DBA, AKA, FKA, division name, etc.\
in place of or combine d with
Debtor’s correct name; filer may add such other names as additional D\
ebtors if desired (but this is neither required nor recomm ended).
1c. Enter a mailing address for the Debtor named in item 1a or 1b.
2. Additional Debtor’s name. If an additional Debtor is included, complete item 2, determined and \
formatted per Instruction 1. For additional Debtors,
attach either Addendum (Form UCC1Ad) or Additional Party (Form UCC1AP\
) and follow Instruction 1 for determining and formatting additional
names.
3. Secured Party’s name. Enter name and mailing address for Secured Party or Assignee who will \
be the Secured Party of record. For additional
Secured Parties, attach either Addendum (Form UCC1Ad) or Additional Pa\
rty (Form UCC1AP). If there has been a full assignment of the initial
Secured Party’s right to be Secured Party of record before filing thi\
s form, either (1) enter Assignor Secured Party‘s name and mailing address in
item 3 of this form and file an Amendment (Form UCC3) [see item 5 of t\
hat form]; or (2) enter Assignee’s name and mailing address in item 3 of
this form and, if desired, also attach Addendum (Form UCC1Ad) giving A\
ssignor Secured Party’s name and mailing address in item 11.
4. Collateral. Use item 4 to indicate the collateral covered by this financing statem\
ent. If space in item 4 is insufficient, continue the collateral
description in item 12 of the Addendum (Form UCC1Ad) or attach additio\
nal page(s) and incorporate by reference in item 12 (e.g., See Exhibit A).
Do not include social security numbers or other personally identifiable \
information.
Note : If this financing statement covers timber to be cut, covers as-extracted collateral, and/or \
is filed as a fixture filing, at tach Addendum (Form
UCC1Ad) and complete the required information in items 13, 14, 15, and \
16.
5. If collateral is held in a trust or being administered by a decedent’\
s personal representative, check the appropriate box in item 5. If more than one Debtor has an interest in the described collateral and the check box doe\
s not apply to the interest of all Debtors, the filer should consider filing a
separate Financing Statement (Form UCC1) for each Debtor.
6a. If this financing statement relates to a Public-Finance Transaction, Man\
ufactured-Home Transaction, or a Debtor is a Transmitting Utility, check the appropriate box in item 6a. If a Debtor is a Transmitting Utility
and the initial financing statement is filed in connection with a Public-Fi\
nance
Transaction or Manufactured-Home Transaction, check only that a Debtor is a Transmitting Utility.
6b. If this is an Agricultural Lien (as defined in applicable state’s en\
actment of the Uniform Commercial Code) or if this is not a UCC security interest filing (e.g., a tax lien, judgment lien, etc.), check the appropriate \
box in item 6b and attach any other items required under other law.
7. Alternative Designation. If filer desires (at filer's option) to use the designations lessee \
and lessor, consignee and consignor, seller and buyer
(such as in the case of the sale of a payment intangible, promissory note, account or chattel paper), bailee and bailor, or lic ensee and licensor
instead of Debtor and Secured Party, check the appropriate box in item 7.
8. Optional Filer Reference Data. This item is optional and is for filer's use only. For filer's conven\
ience of reference, filer may enter in item 8 any
identifying information that filer may find useful. Do not include soci\
al security numbers or other personally identifiable in formation.
FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11. ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b)
12. ADDITIONAL SPACE FOR ITEM 4 (Collateral) :
OR
UCC FINANCING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS
9. NAME OF FIRST DEBTOR: Same as line 1a or 1b on Financing Statement; if line 1b was left blank
because Individual Debtor name did not fit, check here
9a. ORGANIZATION'S NAME
9b. INDIVIDUAL'S SURNAME
ADDITIONAL NAME(S)/INITIAL(S)
FIRST PERSONAL NAME
10. DEBTOR'S NAME : Provide (10a or 10b) only one additional Debtor name or Debtor name that did not fit in line 1b or\
2b of the Financing Statement (Form UCC1) (use exact, full name;
do not omit, modify, or abbreviate any part of the Debtor’s name) an\
d enter the mailing address in line 10c
OR
10a. ORGANIZATION'S NAME
10b. INDIVIDUAL'S SURNAME
OR 11b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME
POSTAL CODE
11c. MAILING ADDRESS CITY ADDITIONAL NAME(S)/INITIAL(S)
STATE SUFFIX
COUNTRY
11a. ORGANIZATION'S NAME
17. MISCELLANEOUS:
SUFFIX
16. Description of real estate:
POSTAL CODE
CITY
10c. MAILING ADDRESS INDIVIDUAL’S FIRST PERSONAL NAME
INDIVIDUAL’S ADDITIONAL NAME(S)/INITIAL(S)
STATESUFFIX
COUNTRY
15. Name and address of a RECORD OWNER of real estate described in item 16
(if Debtor does not have a record interest):
14. This FINANCING STATEMENT: covers timber to be cut covers as-extracted collateral
This FINANCING STATEMENT is to be filed [for record] (or recorded) in \
the
REAL ESTATE RECORDS (if applicable) 13.
is filed as a fixture filing International Association of Commercial Administrators (IACA)
Instructions for UCC Financing Statement Addendum (Form UCC1Ad)
Please type or laser-print this form. Be sure it is completely legible. \
Read and follow all Instructions; use of the correct name for the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequen\
ces. If you have questions, consult your attorney. The filing office cannot give legal advice.
ITEM INSTRUCTIONS
9. Name of first Debtor. Enter name of first Debtor exactly as shown in item 1 of Financing Sta\
tement (Form UCC1) to which this Addendum relates.
The name will not be indexed as a separate debtor. The Debtor name in t\
his section is intended to cross-reference this Addendum with the related
Financing Statement (Form UCC1).
If the box in item 1 of the Financing Statement (Form UCC1) was checke\
d because Individual Debtor name did not fit, the box in item 9 of this
Addendum should be checked.
10. Additional Debtor’s name. If this Addendum adds an additional Debtor, complete item 10 in accord\
ance with Instruction 1 of Financing
Statement (Form UCC1). For additional Debtors, attach either an addit\
ional Addendum or Additional Party (Form UCC1AP) and follow Instruction
1 of Financing Statement (Form UCC1) for determining and formatting ad\
ditional names.
11. Additional Secured Party’s name or Assignor Secured Party’s name. If this Addendum adds an additional Secured Party, complete item 11
in accordance with Instruction 3 of Financing Statement (Form UCC1). \
For additional Secured Parties, attach either an additional Addendum
or Additional Party (Form UCC1AP) and complete applicable items in acc\
ordance with Instruction 3 of Financing Statement (Form UCC1). In
the case of a full assignment of the Secured Party’s interest before \
the filing of this financing statement, if filer has provided the name and mailing
address of the Assignee in item 3 of Financing Statement (Form UCC1), \
filer may enter Assignor Secured Party’s name and mailing address in
item 11.
12. Additional Collateral Description. If space in item 4 of Financing Statement (Form UCC1) is insufficien\
t or additional information must be
provided, enter additional information in item 12 or attach additional p\
age(s) and incorporate by reference in item 12 (e.g., See Exhibit A). Do
not include social security numbers or other personally identifiable inf\
ormation.
13-16. Real Estate Record Information. If this Financing Statement is to be filed in the real estate records \
and covers timber to be cut, covers as-
extracted collateral, and/or is filed as a fixture filing, complete item\
s 1-4 of the Financing Statement (Form UCC1), check the box in item 13, check
the appropriate box in item 14, and complete the required information in\
items 15 and 16. If the Debtor does not have an interest of record, enter
the name and address of the record owner in item 15. Provide a sufficie\
nt description of real estate in accordance with the applicable law of the
jurisdiction where the real estate is located in item 16. If space in i\
tems 15 or 16 is insufficient, attach additional page(s) and incorporate by
reference in items 15 or 16 (e.g., See Exhibit A), and continue the re\
al estate record information. Do not include social security numbers or other
personally identifiable information.
17. Miscellaneous. Under certain circumstances, additional information not provided on th\
e Financing Statement (Form UCC1) may be required.
Also, some states have non-uniform requirements. Use this space or atta\
ch additional page(s) and incorporate by reference in item 17 (e.g., See
Exhibit A) to provide such additional information or to comply with suc\
h requirements; otherwise, leave blank. Do not include social security
numbers or other personally identifiable information.