Fill and Sign the Request for Information or Copies Ucc 11

B. RETURN TO: (Name and Address) INFORMATION REQUEST REQUEST FOR INFORMATION OR COPIES - UCC-11 NORTH DAKOTA SECRETARY OF STATE / COUNTY RECORDERS SFN 14005 (12-13-04) A. NAME & PHONE OF CONTACT FILING OFFICE ACCT# 1. DEBTOR NAME to be searched - insert onlyonedebtor name (1a or 1b) - do not abbreviate or combine names FOLLOW INSTRUCTIONS (front and back) CAREFULLY THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1a. ORGANIZATION'S NAME 1b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME or 2. INFORMATION OPTIONS relating to UCC filings and other notices on file in the filing office that include as a Debtor name the name identified in item 1: 2a. SEARCH RESPONSE CERTIFIED (Optional) Select one of the following two options: ALL (Check this box to request a response that is complete, including filings that have lapsed.) UNLAPSED 2b. COPY REQUEST Select one of the following two options:CERTIFIED (Optional) ALL UNLAPSED 2c. SPECIFIED COPIES ONLY CERTIFIED (Optional) Fax - Fax number ______________________________________ Other 5a. 5b. 5. DELIVERY INSTRUCTIONS (request will be completed and mailed to the address shown in item B unless otherwise instructed here): 4. Comments 3. NORTH DAKOTA OFFICE OFFERS THE FOLLOWING ADDITIONAL SEARCH SERVICES: 3a. Search by SSN/TIN ___________________________________________ 3b. Additional Search criteria: Up to two cities may be inserted __________________________ & ________________________; or All North Dakota Exclude Requesting Party's Filings Requesting Party's Filings only 3c.Additional Search Options: A listing of all unlapsed filings (including Terminations) since _____________________________ to current certification date Date A listing of unlapsed filings from _____________________________ to _________________________ Date Date Provide copies with listing Copies only of Unlapsed filings from _________________________ to ___________________________ Date Date 3d. Certified Copy with Official Seal 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.) 3e. All UCC Index Statutory Lien Federal State Tax Farm Products Agricultural Index Lien Index Liens Central Notice Stat. Notice Please check the box for each index you wish searched for the above debtor name or SSN/TIN or file number(s). If no box is checked, the search will reflect UCC filings only. 1c. Search Preference: General or Specific UCC-11 INSTRUCTIONS SFN 14005 (12-13-04) To assist filing officers that might wish to communicate with the requestor, requestor may provide information in item A. This item is optional. Customer's may request to be billed for services. This number must be typed on the form for accurate billing processing. Without a customer number all fees must be paid at the time of submitting the search request. Any fees due over the amount submitted will be billed. Enter name and address of requestor in item B. This item is not optional . 1. Debtor name: Enter only one Debtor name in item 1, an organization's name (1a) or an individual's name (1b). Enter Debtor's exact full legal name . Do not abbreviate. To search by SSN/TIN see 3a. 1a. Organization Debtor. "Organization" means an entity having a legal identity separate from its owner. A partnership is an organization; a sole proprietorship is not an organization, even if it does business under a trade name. 1b. Individual Debtor . "Individual" means a natural person; this includes a sole proprietorship, whether or not operating under a trade name. Don't use prefixes (Mr., Mrs., Ms) use married woman's personal name. Enter individual Debtor's family (Mary Smith, not Mrs. John Smith). Enter Debtor's family name (surname) in Last Name box, first given name is First Name box, and all additional given names in Middle Name box. For both organization and individual Debtors : Don't use Debtor's trade name, DBA, AKA, FKA, Division name, etc. in place of or combined with Debtor's legal name. 1c. General Name Search: You will receive information on all active filings for names alphabetically after last letter provided. Items 2 and 3. Request an item by marking the appropriate box. At least one type must be marked. All searches are certified. 2. Information options relating to UCC filings and other notices on file in the Central Indexing System that includes as a Debtor name the name identified in item 1. 2a. Check appropriate box in item 2a; the box "ALL" if you are requesting a search of all active records, including lapsed filings, or the box "UNLAPSED" if you are requesting a search of only active records that have not lapsed. 2b. Check appropriate box in item 2b; to request copies of record appearing on the search response; the box "ALL" if you are requesting copies of all active records, including lapsed filings. 2c. Complete item 2c if you are ordering copies of specific records by file number. 3. You can limit or expand your search by using the following options: 3a. SSN/TIN: You may request a search by social security number or tax identification number. 3b. You may limit your search to one or two cities or all North Dakota. You may exclude or include Requesting Party. 3c. Additional Search Types: 3d. Certified copy with Seal of each filing identified by file number. Original filings will include all pages of the original filings and all amendments. 3e. Indexes to be Searched: Check the specific index system to be searched. If no box is checked search will reflect UCC filings only. 4. Comments: This space is provided to make additional comments regarding the search request. 5. Delivery Instructions: Unless otherwise instructed, filing office will mail information to the name and address in item b. If information is to be faxed check the "FAX" box and provide fax number. If other than mail or fax, check the "OTHER" box and specify the other delivery method that your are requesting. 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 billing is provided. A. B. First five entries Each additional five entries or fraction thereof A. Type of Search: $7.00 $2.00 $7.00 $2.00 A. B.Certificate per filing Each additional page after first page 3. Certified copies with State Seal: 2.Copy request with certificate: A. B.Certificate and first three pages Copy per page thereafter $7.00 $1.00 1.Information request with certificate:B. Information Faxed: Additional Charge (up to 20 pages) 1. $3.00 A. B. Please type or laser-print this form. Be sure it is completely legible. Read all instructions. Follow instructions completely. Fill in form very carefully; mistakes may have important legal consequences. if you have questions, consult your attorney. Filing office cannot give legal advice. Do not insert anything in open space in the upper portion of this form; it is reserved for filing office use. When properly completed, send or fax the original and one copy toany County Recorder's office or the Secretary of State's Office. FEES: