Fill and Sign the Information Request Ucc Information Request Form

INFORMATION REQUEST FOLLOW INSTRUC TIONS A. NAME & PHONE OF CONTACT AT FILER (optional) FILING OFFICE ACCT # B. NAME & PHONE OF CONTACT (optional) C. RETURN TO: (Name and Address) THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1. 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 OR 1b. INDIVIDUAL'S SURNAME INDIVIDUAL'S FIRST PERSONAL NAME INDIVIDUAL'S ADDITIONAL NAME(S)/INITIAL(S) SUFFIX 2. INFORMATION OPTIONS relating to UCC filings and other notices on file in the filing office th at include the Debtor name the name identified in item 1: 2a. DEBTOR NAME REQUEST CERTIFIED (Optional) 2b. COPY REQUEST CERTIFIED (Optional) 2c. SPECIFIED COPIES ONLY CERTIFIED (Optional) Record Number Date Record Filed (if required) Type of Record and Additional Information (if required) 3. ADDITIONAL SERVICES: 4. DELIVERY INSTRUCTIONS (request will be completed and mailed to the address shown in item C unless otherwise instructed here): 4a. Pick Up 4b. Other Specify desired method here (if available from this office); provide delivery inform ation (e.g., delivery service’s name, addressee’s account # w ith deli very service, addressee’s phone #, etc.) 5. OREGON FEES: a. Debtor Name Request...............….. b. Debtor Name Request w/Copies. … c. Document Number Request............ d. Certified Copies............................... $10 per name $15 per name $5 per name $15 per number 411 UCC11 - FILING OFFICE COPY – INFORMATION REQUEST (FORM UCC11) (Rev . 06/13) Instructions for Information Request (Form UCC11) Please type or laser-print this form. Be sure it is complet ely legible. Read and follow all Instructions, especially Instruc tion 1; use of the correct name for the Debtor is crucial. Fill in form very carefully; mistakes may have important lega l consequences. If you have questions, consult your attorney. The filing office cannot give legal advice. Send completed form parts 1 and 2 (labeled Filing Office Copy (1) and (2)) to: Secretary of State Corporation Division/UCC Section 255 Capitol St. NE, Ste. 151 Salem, Oregon 97310 with the required fee. Filing office may offer additional information options. Contact f iling office or use form specially designed by filing office to obtain additional information options. ITEM INSTRUCTIONS A and B. To assist filing offices that might wish to communic ate with filer, filer may provide information in item A and item B. These items are optional. C. Provide name and address of requestor in item C. This it em is NOT optional. 1. 1a. 1b. 2. 2a. 2b. 2c. 3. 4. 4a. 4b. 5. Debtor’s name. Enter only one Debtor name in item 1 -- either an organization's name (1a) or an individual’s name (1b) . Enter Debtor's correct name . Do not abbreviate words that are not already abbreviated in the Debtor’s name. Organization Debtor Name . “Organization Name” means the name of an entity that is not a natural person. A sole proprietorship is not an organization, even if the individual proprietor does busine ss under a trade name. If Debtor is a registered organization (e.g., corporation, limited partnership, limited liability company), it is adv isable to examine Debtor’s current filed public organic r ecords 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 n ame. Individual Debtor Name . “Individual Name” means the name of a natural person; th is includes the name of an individual doing business as a sole proprietorship, whether or not operating under a trade na me. The term includes the name of a decedent where collat eral is be ing administered by a personal representative of the decedent. The term does not include the name of an entity, even if it contain s, 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. Ent er individual Debtor’s surname (family name) in Individual’s Surname box, first perso nal name in First Personal Name box, and all additional name s 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 boxe s blank. For both organization and individual Debtors . Do not use Debtor’s trade name, DBA, AKA, FKA, div ision name, etc. in place of or combined with Debtor’s correct name; filer may add such other names as additional Debtors if desired (but this is neither required nor recommended). Information Options. Information options relating to UCC filings and other notice s on file in the filing office that include as a Debtor name the name identified in item 1. Please note that it is permissible to select an option in 2a and also check an opti on in 2b. Check only 2c if you want copies on a specific record number. Check the "CERTIFIED (Optional)" box appropriately in items 2a, 2b, or 2c. Check appropriate box in item 2a if you are requesting an o fficial Debtor Name search of all unlapsed records. Check the “CERTIFIED” box for a state seal certified se arch. Note that you must also check 2b “CERTIFIED”. Check appropriate box in item 2b to request copies of reco rds appearing on the search response. Check the “CERTIFIED” box for a state seal certif ied copies search. Complete item 2c only if you are ordering copies of specific records by record number. Check the “CERTIFIED” box for a state seal cer tified copy search. Additional Services. Some filing offices offer service options in addition to thos e offered in item 2. These may be shown on the face of this form or may otherwise be publicized by the particular filing office. Caution: if any of these additional service options introduces a search criterion (e.g., limiting search to named Debtor at an address in a specified city and state) that narrows the scope of the search, this may result in an incomplete search (that fails to list all filings against the named Debtor) and you may fail to learn information tha t might be of value to you. Delivery Instructions. Unless otherwise instructed, filing office will mail informa tion to the name and address in item C. Contact filing office concerning availability of other delivery options. Check ap propriate box (4a or 4b) if optional services are available from the filing office and are being requested. If information is to be picked up from the filing office, check the "Pick Up" box. For other than mail or pick up, check the "Other" box and specify the other delivery method that is being requ ested. If requesting delivery service, provide delivery service's name and requestor's account number to bill for delivery charge. Filing office will not deliver by delivery service unless prepaid waybill or account number for billin g is provided. Oregon Secretary of State UCC fees.