Fill and Sign the Fillable Online Tn Vsp Vision Cancellation Request Form

FARM PRODUCTS CENTR AL NOTICE CNS-1 D. Transmitting Utility G. ASSIGNEE NAME AND ADDRESS (if any) 2. 4. This FARM PRODUCT Central Notice filing is presented to the filing officer pursuant to NDCC 41-09-40.Signature of Debtor and Secured Party required. J. COUNTY CODE UNIFORM COMMERCIAL CODE FINANCING STATEMENT STANDARD UCC-1/CNS-1NORTH DAKOTA SECRETARY OF STATE/COUNTY RECORDERS SFN 14009 (09-27-01 ) Reserved for Filing Officer Use I. This financing statement covers the following collateral: (If filing in Farm Products Central Notice, include a reasonable description of the property, including the county in which the property is located.) E. Debtor's Exact Full Legal Name - do not abbreviate or combine names If individual Last Name First Individual Organization SSN or TIN B. Customer Billing Number F. SECURED PARTY NAME AND ADDRESS (from which security info is obtainable) DESCRIPTION (if applicable) FARM PRODUCT CODECROP YEAR (if applicable)QUANTITY (if applicable)DESCRIPTION (if applicable) COUNTY CODEFARM PRODUCT CODECROP YEAR (if applicable)QUANTITY (if applicable) 1. 3. 5. Please do not type outside of bracketed area C. Submitted By Facsimile FAX # A.FileIn UCC Index Farm Products Central Notice (CNS) PLE ASE T YPE.Please read instructions on back before com pletin g. RETURN ACKNOWLEDGEMENT COPY TO: (name and address) H. Check If Covered: ADD'L INFO RE ORGANIZATION DEBTOR TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE ADD'L INFO RE ORGANIZATION DEBTOR TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE 2. _______________________________________________________ ________________________ ADDRESS: __________________________________________________________________________ SSN/TIN: Telephone # Telephone # SSN/TIN: By _________________________________________ Name & Title Secured Party Signature ____________________________________________________________ 1. ___________________________________________________ ____________________________ ADDRESS: __________________________________________________________________________ PROCEEDS PRODUCTS Individual Organization K. Debtor Signature _____________________________________________________________________________________________________________ By_____________________________________________ Name & Title By _____________________________________________ Name & Title By ____________________________________________ Name & Title6. FARM PRODUCTS CENTR AL NOTICE CNS-1 D. Transmitting Utility G. ASSIGNEE NAME AND ADDRESS (if any) 2. 4. This FARM PRODUCT Central Notice filing is presented to the filing officer pursuant to NDCC 41-09-40.Signature of Debtor and Secured Party required. J. COUNTY CODE UNIFORM COMMERCIAL CODE FINANCING STATEMENT STANDARD UCC-1/CNS-1NORTH DAKOTA SECRETARY OF STATE/COUNTY RECORDERS SFN 14009 (09-27-01 ) Reserved for Filing Officer Use I. This financing statement covers the following collateral: (If filing in Farm Products Central Notice, include a reasonable description of the property, including the county in which the property is located.) E. Debtor's Exact Full Legal Name - do not abbreviate or combine names If individual Last Name First Individual Organization SSN or TIN B. Customer Billing Number F. SECURED PARTY NAME AND ADDRESS (from which security info is obtainable) DESCRIPTION (if applicable) FARM PRODUCT CODECROP YEAR (if applicable)QUANTITY (if applicable)DESCRIPTION (if applicable) COUNTY CODEFARM PRODUCT CODECROP YEAR (if applicable)QUANTITY (if applicable) 1. 3. 5. Please do not type outside of bracketed area C. Submitted By Facsimile FAX # A. File In UCC Index Farm Products Central Notice (CNS) PLE ASE T YPE.Please read instructions on back before com pletin g. RETURN ACKNOWLEDGEMENT COPY TO: (name and address) H. Check If Covered: ADD'L INFO RE ORGANIZATION DEBTOR TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE ADD'L INFO RE ORGANIZATION DEBTOR TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE 2. _______________________________________________________ ________________________ ADDRESS: __________________________________________________________________________ SSN/TIN: Telephone # Telephone # SSN/TIN: By _________________________________________ Name & Title Secured Party Signature ____________________________________________________________ 1. ___________________________________________________ ____________________________ ADDRESS: __________________________________________________________________________ PROCEEDS PRODUCTS Individual Organization K. Debtor Signature _____________________________________________________________________________________________________________ By_____________________________________________ Name & Title By _____________________________________________ Name & Title By ____________________________________________ Name & Title6. Acknowledgment Copy UCC-1/CNS-1 INSTRUCTIONS SFN 14009 (09-27-01) A. B. C. D. E. F. G. H. I. J. K.You may use this form to file in either the UCC Index or CNS Index or both. If neither box is marked, the filing will be considered a UCC filing only. CUSTOMER BILLING #: Clients may request to be billed for services. Upon approval a customer billing number is provided. This number needs to be typed on the form for accurate billing processing. Check if applicable. Be sure to include your fax number if submitting by fax. Check if the debtor is a transmitting utility. DEBTOR NAME: Individual or Oranization - Check one per debtor. If an individual, enter last name, first name and middle name. For a business, begin with the first word or character not an article or punctuation mark. Provide a complete mailing address for all debtors. Social Security Number (SSN) or Tax Identification Number (TIN) must be provided for each debtor. If debtor is an organization the additional information must be provided: type of organization, jurisdiction of organization, and organizational ID number (if any) or check none. SECURED PARTY NAME: Enter the name of all secured parties and an address and telephone number from which security information is obtainable. SSN/TIN number for each secured party is optional. ASSIGNEE NAME: Follow same instructions as with "F". PROCEEDS, PRODUCTS: If proceeds and/or products are to be covered, indicate by marking an "X". DESCRIBE THE COLLATERAL. A description of collateral is necessary for filing. If collateral is filed in Farm Products Central Notice, include a reasonable description of the property, including the county in which the property is located. FARM PRODUCTS: List the county code from the list below for the county where produced. List the appropriate farm product code from the list below. A more specific description of the farm product may be entered. If "crop year" and/or "quantity" are left blank, the default will be "ALL". Each farm product must be listed separately. SIGNATURES: ALL DEBTORS AND SECURED PARTIES ARE REQUIRED TO SIGN THE CNS-1 PORTION FOR FILING IN CENTRAL NOTICE INDEX. 1. 2. 3. 4.If the space provided for any item on this form is inadequate use UCC-5/CNS-5 form as an attachment. Verify for accuracy and correct spelling. Submit the original and one copy to any County Recorders' office or the Secretary of State's office. Refer to the user's guide for further information. The guide may be purchased from the Secretary of State's office. The following letters correspond to the lettered sections on the front of this form. 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Adams Barnes Benson Billings Bottineau Bowman Burke Burleigh Cass Cavalier Dickey Divide Dunn Eddy Emmons Foster Golden Valley Grand Forks Grant Griggs Hettinger Kidder LaMoure Logan McHenry McIntosh McKenzie 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Wheat/Durum Rye Barley Corn Oats Sorghum Buckwheat Triticale Flax Soybeans Sunflowers Safflowers Mustard Millet Rape Seed Potatoes Beans Peas Sugar Beets Hay/Alfalfa Grasses Clover Wool Eggs MilkCheese/Whey Cream Lentils Honey Bees Wax Berries Fruits Trees/Shrubs Herbs Garlic Popcorn Canola Crambe Pellets Fourage Silage Speltz Sunwheat Onions Carrots Squash Vegetables Pumpkins Borage Chick Peas Amaranth Mint 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Cattle/Calves Beefalo Buffalo Hogs Sheep/Lambs Horses Mules Chickens Ducks Geese Turkeys Bees Goats Fox Furs/Pelts Fish Pheasants Game Hens Llamas Elk Ostriches Rabbits Emus Rhea Bird Deer Bull Semen Dogs Worms 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 McLean Mercer Morton Mountrail Nelson Oliver Pembina Pierce Ramsey Ransom Renville Richland Rolette Sargent Sheridan Sioux Slope Stark Steele Stutsman Towner Traill Walsh Ward Wells Williams OutofState 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 1. Filing both UCC-1 and CNS-1/Termination 2. Filing only UCC-1 Portion/Termination 3. Filing only CNS-1 Portion/Termination 4. Non-Standard Filing/Termination 5. Additional Attachments Per Typed Page (8 1/2 X 11)$20.00 $1.00 $15.00 $15.00 $15.00 PRODUCT CODESCOUNTY CODES FEES: See user's guide for further explanation of fees. RETURN ACKNOWLEDGEMENT COPY: Complete to whom acknowledgement copy should be sent.