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TN FORM UCC1 (12/1/2016
)
Business Services Division
Tre Hargett, Secretary of State
State of Tennessee
INSTRUCTIONS
UCC Financing Statement (TN Form UCC1)
Filing Fee: $15.00 per Debtor
Recording Tax due upon filing (see instructions)
Pursuant t o T.C.A. § 3 9 -1 7 -1 1 7 , it is a Class E f elony f or any person t o k now i ngly prepare, sign, or
f ile any lien or ot her docum ent w it h t he int ent t o encum ber any real or personal proper t y w hen
such person has no reasonable basis or any lega l ca use t o place such lien or e ncum brance on such
real or personal proper t y.
A blank form follows these instructions.
A UCC1 financing statement may be filed using one of the following methods:
• E-file: Go to
http://tnbear.tn.gov/UCC . Use the online tool to complete the filing and pay the filing fee
and indebtedness tax by credit card, debit card or e-check . When paying by credit card, debit card or e-
check , there is a convenience fee that covers the credit card fees and transaction costs incurred by the
Business Services Division when accepting online payments. Filers who do not wish to pay the
convenience fee to file online may choose the “Print and Mail” option at no addit ional cost.
• Print and Mail: Go to
http://tnbear.tn.gov/UCC . Use the online tool to complete the filing. Print and mail
the application along with the required filing fee and recording tax to the Secretary of State’s office at
ATTN: UCC, 312 ROSA L PARKS AVE #6, NASHVILLE TN 37243 -1102 .
• Paper submission: A blank form follows these instructions. The form must be hand printed in black ink
or computer generated and mailed along with the required filing fee and recording tax to the Secretary of
State’s office at ATTN: UCC, 312 ROSA L PARKS AVE #6, NASHVILLE TN 37243 -1102 .
• Walk -in: A blank UCC1 form may be obtained in person at the Secretary of State Business Servic es
Division located on the 6th
F loor of the Snodgrass Tower at 312 Rosa L. Parks AVE, Nashville, TN 37243.
Please type or laser-print this form. Be sure it is legible. Read all instructions, especially instruction 1; correct
Debtor name is crucial. Follow instructions completely.
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Fill in form very carefully; mistakes may have important legal cons
equences. If you have questions, consult your
attorney. Filing office cannot give legal advice.
Do not write in any area of the form other than in the designated application box sections.
If you need to provide additional information, you must use a UCC Financing Statement Addendum form (TN
Form UCC1Ad) or a UCC Financing Statement Additional Party form (TN Form UCC 1Ap).
To assist the filing office in communicating with the filer to resolve any issues , the filer may provide information in
item s A and B .
Complete item C if you want an acknowledgment sent to you and your original documents returned .
1. 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 exact full legal name. Do not abbreviate. Name fields are a maximum
of 256 characters in length.
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. If Debtor is a partnership, enter the exact full legal name of the partnership. You need not enter
names of partners as additional Debtors. If Debtor is a registered organization (e.g., corporation, limited
partnership, limited liability company), it is advisable to examine the Debtor’s current filed formation documents
to determine the exact legal name of the Debtor .
1b. INDIVIDUAL DEBTOR - “Individual” means a natural person; this includes a sole proprietorship, whether or
not operating under a trade name. Do not use prefixes (Mr., Mrs., Ms.). Use suffix box only for titles of li neage
(Jr., Sr., III) and not for other suffixes or titles (e.g., M.D.). Use a married woman’s personal name (Mary Smith,
not Mrs. John Smith). Enter individual Debtor’s family name in INDIVIDUAL’S SURNAME box, first given name
in FIRST PERSONAL NAME box, and all additional given names in ADDITIONAL NAME(S) INITIAL(S) box.
Individual Debtor’s name should be the same as the name on the Debtor’s valid Tennessee driver ’s license or
photo identification license , if applicable.
For both organization and individual Debtors: do not use Debtor’s aliases (e.g. trade name, DBA, AKA, FKA,
d ivision name ) in place of or combined with Debtor’s legal name; you may add such other names as additional
Debtors if you wish (this is neither required nor recommended).
1c. MAILING ADDRESS - A complete address is always required for the Debtor named in 1a or 1b. Our system
will standardize the address in USPS format.
2. DEBTOR’S NAME - If an additional Debtor is included, complete item 2, determined and formatted per
instruction 1. To include further additional Debtors, or one or more additional Secured Parties, attach a UCC
Financing Statement Addendum form (TN Form UCC1Ad) using correct name format. Follow instruction 1 for
determining and formatting additional names.
3. SECURED PARTY’S NAME - Enter information for Secured Party or Total Assignee, determined and
formatted per instruction 1. To include further additional Secured Partie s, attach either a UCC Financing
Statement Addendum form (TN Form UCC1Ad) or a UCC Financing Statement Add itional Party form (TN
Form UCC1A p) using correct name format. Follow instruction 1 for determining and for matting additional
names. If there has been a total assignment of the Secured Party’s interest prior to filing this form, you may
either (1) enter Assignor Secured Party ‘s name and address in item 3 and file an Amendment (Form UCC3)
[see item 5 of that form]; or (2) enter Total Assignee’s name and address in item 3 and, if you wish, also attach
Addendum (Form UCC1Ad) giving Assignor Secured Party ’s name and address in item 12.
4. COLL ATER AL - Use item 4 to indicate the collateral covered by this Financing Statement. If space in item 4 is
insufficient, put the entire collateral description or continuation of the collateral description on UCC1
Addendum (Form UCC1Ad ). Pursuant to T.C.A. § 67 -4- 409(b) e very recorded instrument evidencing an
indebtedness must contain, either on the face of the instrument or in an attac hed sworn statement, the
following language: "Maximum principal indebtedness for Tennessee recording tax purposes is $_____."
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5.
If the collateral is held in Trust or being administered by a Decedent’s Personal Representative, check the
appropriate box in item 5.
6a. If the filing is a Public -Finance Transaction, a Manufactured -Home Transaction, or if the Debtor is a
T ransmitting Utility, select the appropriat e box in 6a.
6b. If this is an agricultural lien (as defined in applicable Commercial Code) filing or is otherwise 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 r equired under other law.
7. ALTERNATIVE DESIGNATION - If filer desires (at filer's option) to use titles of lessee and less or, or
consignee and consignor, or seller and buyer (in the case of accounts or chattel paper), or bailee and bailor , or
licensee 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. Filer may enter in
item 8 any identifying information (e.g., Secured Party's loan number, law firm file number, Debtor's name or
other identification, state in which form is being filed, etc.) that f iler may find useful. Do not include confidential
personal information such as birth dates or social security numbers.
Filing Fee and Recording Tax
• The filing wizard (
http://tnbear.tn.gov/UCC ) correctly calculates both the filing fee and the recording tax.
• The filing fee is $15 .00 per Debtor.
• There is an additional fee of fifty cents ($0.50) per page for each page in excess of ten (10) pages.
• The recording tax is calculated at 11.5 cents for each $100 .00 of indebtedness. The first $2 ,000.00 is tax
exempt. In order to properly calculate the recording tax due, the full indebt edness amount must be provided.
The filing wizard calculates the tax due taking into consideration the $ 2,000.00 exemption and any taxes you
report as paid to another jurisdiction. If Debtor is exempt from the recording tax, the maximum principal
indebtedn ess amount should be listed as $0.00.
• Make check, cashier’s check or money order payable to the Tennessee Secretary of State. Cash is only
accepted for walk -in filings. Filings submitted without the proper filing fee and recording tax will be rejected.
Checks, cashier’s checks or money orders made out to any payee other than th e Tennessee Secretary of
State will not be accepted and will result in the rejection of the document.
UCC FINANCING STATEMENT (TN FORM UCC1) (REV. 12/1/20 16)
1. DEBTOR’S NAME: 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); if any part of the Individual Debtor’s name will not �t 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)
3. SECURED PARTY’S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only one Secured Party name (3a or 3b)
3a. ORGANIZATION’S NAME
3b. INDIVIDUAL’S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S) INITIAL(S) SUFFIX
3c. MAILING ADDRESS CITYS TAT EPOSTAL CODE COUNTRY
UCC FINANCING STATEMENT FOLLOW INSTRUCTIONS
1a. ORGANIZATION’S NAME
1b. INDIVIDUAL’S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S) INITIAL(S) SUFFIX
2. DEBTOR’S NAME: Provide only one Debtor name (2a or 2b) (use exact full name; do not omit, modify, or abbreviate any part of the Debtor’s name);
if any part of the individual Debtor’s name will not �t 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)
OR THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1c. MAILING ADDRESS
CITYS TAT EPOSTAL CODE COUNTRY
2a. ORGANIZATION’S NAME
2b. INDIVIDUAL’S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S) INITIAL(S) SUFFIX
2c. MAILING ADDRESS CITYS TAT EPOSTAL CODE COUNTRY
A. NAME & PHONE OF CONTACT AT FILER (Optional)
B. EMAIL CONTACT AT FILER (Optional)
C. SEND ACKNOWLEDGMENT TO: (Name and Address)
OR
OR 4. COLLATERAL: This �nancing statement covers the following collateral:
Maximum principal indebtedness for Tennessee recording tax purposes is $
NOTE: All information on this form is public record.
6a. Check only if applicable and check only one box:
Public-Finance Transaction Manufactured-Home Transaction A Debtor is a Transmitting Utility 6 b. Check only if applicable and check only one box:
Agricultural Lien Non-UCC Filing
7. ALTERNATIVE DESIGNATION (if applicable): Lessee/Lessor Consignee/Consignor Seller/Buyer Bailee/Bailor Licensee/Licensor
8. OPTIONAL FILER REFERENCE DATA:
5. Check only if applicable and check only one box: Collateral is held in Trust (see UCC1Ad, Item 17 and instructions)
being administered by a Decedent’s Personal Representative
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