UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
B. SEND ACKNOWLEDGMENT TO: (Name and Address)THE ABOVE SPACE IS FOR FILING OFFICE USE ONL
Y
1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (1a or \
1b) - do not abbreviate or combine names 1a. ORGANIZATION'S NAME OR 1b. INDIVIDUAL'S LAST NAMEFIRST NAMEMIDDLE NAMESUFFIX
1c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
ADD'L INFO RE 1d. TYPE OF ORGANIZATION 1e. JURISDICTION OF ORGANIZATION
ORGANIZATION
DEBTO
R none
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor na\
me (2a or 2b) - do not abbreviate or combine names 2a. ORGANIZATION'S NAME
UCC 201 Page 1 of 6Last Revision: 11/04/08
OR 2b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
2c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
ADD'L INFO RE 2d. TYPE OF ORGANIZATION 2e. JURISDICTION OF ORGANIZATION
ORGANIZATION
DEBTOR
none
3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - \
insert only one secured party name (3a or 3b) 3a. ORGANIZATION'S NAME
OR 3b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
3c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
4. This FINANCING STATEMENT covers the following collateral:
5. ALTERNATIVE DESIGNATION [if applicable]:
6. This FINANCING STATEMENT is to be filed [for record] (or reco\
rded) in the REAL 7. Check to REQUEST SEARCH REPORT(S) on Debtor(s)
ESTATE RECORDS. Attach Addendum [if applicable] [optional] [ADDITIONAL FEE]
8. OPTIONAL FILER REFERENCE DATA
FILING OFFICE COPY — (FORM UCC1) (REV. 01/11/08)
LESSEE/LESSORCONSIGNEE/CONSIGNOR BAILEE/BAILORSELLER/BUYER
AG. LIEN NON-UCC FILING
All Debtors
Debtor 1Debtor 2
UCC 201 Page 1 of 6Last Revision: 11/04/08
UCC FINANCING STATEMENT ADDENDU M
FOLLOW INSTRUCTIONS CAREFULLY
9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME
OR 9b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAME, SUFFIX
10. MISCELLANEOUS:
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one name (11a or 11b) - do not abbreviate or combine names
11a. ORGANIZATION'S NAME OR 11b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
11c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
ADD'L INFO RE 11d. TYPE OF ORGANIZATION 11e. JURISDICTION OF ORGANIZATION 11g. ORGANIZATIONAL ID #, if any
ORGANIZATION
DEBTOR
none 12. ADDITIONAL SECURED PARTY'S or ASSIGNOR S/P'S NAME - insert only one name (12a or 12b)
12a. ORGANIZATION'S NAME
12b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
12c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
11d.
SEE INSTRUCTIONS
UCC 201
Page 2 of 6Last Revision: 11/04/08
13. This FINANCING STATEMENT covers 16. Additional collateral description:
timber to be cut or as-extracted collateral, or is filed as a
fixture filing.
15. Name and address of a RECORD OWNER of above-described real estate
(if Debtor does not have a record interest): 17. Check only if applicable and check only one box.
Debtor is a Trust or Trustee acting with respect to prop\
erty held in trust or
Decedent's Estate
18. Check only if applicable and check only one box.Debtor is a TRANSMITTING UTILITY
Filed in connection with a Manufactured-Home Transaction — effective \
30 years
Filed in connection with a Public-Finance Transaction — effective 30 \
years
FILING OFFICE COPY — NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 01/11/\
08)
14. Desciption of real estate:
UCC 201 Page 2 of 6Last Revision: 11/04/08
UCC FINANCING STATEMENT ADDITIONAL PARTY
FOLLOW INSTRUCTIONS CAREFULLY
19. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
NAME
OF PARTY AUTHORIZING THIS AMENDMENT (name as item 9 Amendment form)19a. ORGANIZATION'S NAME
19b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAME SUFFIX
21a. ORGANIZATION'S NAME
OR 21b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
21c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
ADD'L INFO RE 21d. TYPE OF ORGANIZATION 21e. JURISDICTION OF ORGANIZATION
ORGANIZATION
DEBTOR
22a. ORGANIZATION'S NAME
OR 22b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
22c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
22. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (22a or 22b) - do not abbreviate or combine names
21. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one
debtor name (21a or 21b) - do not abbreviate or combine names
20. MISC MISCELLANEOUS
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
OR
UCC 201
Page 3 of 6Last Revision: 11/04/08
ADD'L INFO RE 22d. TYPE OF ORGANIZATION22e. JURISDICTION OF ORGANIZATION
ORGANIZATION
DEBTOR
23a. ORGANIZATION'S NAME
OR 23b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
23c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
ADD'L INFO RE 23d. TYPE OF ORGANIZATION 23e. JURISDICTION OF ORGANIZATION
ORGANIZATION
DEBTOR
24a. ORGANIZATION'S NAME
OR 24b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
24c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
25a. ORGANIZATION'S NAME
OR 25b. INDIVIDUAL'S LAST NAME FIRST NAMEMIDDLE NAMESUFFIX
25c. MAILING ADDRESS CITYSTATE POSTAL CODE COUNTRY
25. ADDITIONAL SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE) - inse\
rt only one secured party name (25a or 25b)
24. ADDITIONAL SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE) - inse\
rt only one
secured party name (24a or 24b)
23. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one
debtor name (23a or 23b) - do not abbreviate or combine names
UCC 201
Page 3 of 6Last Revision: 11/04/08
Pursuant to Ohio Law, our office cannot file or record a document which \
contains a social security
number or tax identification number.
Please DO NOT
provide a social security number, employee identification number, or ta\
x identification number,
in any format, on this form.
Please type or laser-print this form. Be sure it is completely legible.\
Read all instructions, especially instruction
1; correct Debtor name is crucial. Follow instructions completely. Fil\
l in form very carefully; mistakes may have important
legal consequences. If you have questions, consult your attorney. Fili\
ng office cannot give legal advice. DO NOT insert
anything in the open space in the upper portion of this form; it is res\
erved for filing office use. When properly completed,
send filing office copy, with required fee, to filing office. If you wa\
nt an acknowledgment, complete item B and, if filing
in a filing office that returns an acknowledgment copy furnished by file\
r, you may also send Acknowledgment Copy; otherwise
detach. If you want to make a search request, complete item 7 (after r\
eading instruction 7 below) and send Search Report
Copy, otherwise detach. Always detach Debtor and Secured Party Copies.
If you need to use attachments, you are encouraged to use either Amendme\
nt Addendum (Form UCC1AD) or
Amendment Additional Party (Form UCC1AP).
A. To assist filin
g offices that mi ght wish to communicate with filer, filer ma y provide
information in item A. This item is optional
.
B. Complete item B if you want an acknowledgment sent to you. If filing in\
a filing office that returns an acknowledgment copy furnished by filer, present simultan\
eously with
Instructions for UCC Financing Statement (Form UCC1)
UCC 201 Page 4 of 6Last Revision: 11/04/08
this form a carbon or other copy of this form for use as an acknowledgme\
nt copy.
1. Debtor Name:
Enter only one Debtor name in item 1. An organization's name (1a)
or and individual's name (1b). Enter Debtor's exact full legal name
; DO NOT abbreviate.
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 exact
full name of partnership; you need not enter names of partners as addit\
ional Debtors.
If Debtor is a registered organization (e.g., corporation, limited part\
nership, limited liability
company), it is advisable to examine Debtor's current filed charter doc\
uments to
determine Debtor's correct name, organization type, and jurisdiction of \
organization.
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
suffix box only for titles of lineage (Jr., Sr., III) and not for othe\
r suffixes or titles (e.g., M.D.).
Use married woman's personal name (Mary Smith, not Mrs. John Smith). \
Enter
individual Debtor's family name (surname) in Last Name box, first give\
n name in First
Name box, and all additional given names in Middle Name box. For both o\
rganization
and individual Debtors: DO NOT
use Debtor's trade name, DBA, AKA, FKA, Division
name, etc., in place of or combined with Debtor's legal name; you may a\
dd such other
names as additional Debtors if you wish (but this is neither required n\
or recommended).
1c. An address is always required for the Debtor named in 1a or 1b. "Additional information re
gardin g Debtor" is alwa ys required. T ype of or ganizatio n
and jurisdiction of organization as well as Debtor's exact legal name, \
which the filer can
determine by examining the Debtor's current file charter document.
UCC 201 Page 4 of 6Last Revision: 11/04/08
2. If an additional Debtor is included, complete item 2 and format per inst\
ruction.To include further additional Debtors, attach either Addendum (Form UCC\
1AD)
or Additional Party (Form UCC1AP) and follow instruction 1 for enterin\
g additional names.
3. Enter information for Secured Party or Total Assignee, per instruction 1\
. To include further additional Secured Parties, attach either Addendum (Form UCC1AD) or Ad\
ditional Party
(Form UCC1AP) and follow instruction 1 for entering additional names. \
If there has
been a total assignment of the Secured Party's interest prior to filing\
this form, you may
enter Assigned or Secured Party's (S/P's) name and address in item 3 a\
nd
file an Amendment (Form UCC3).
4. Use item 4 to indicate the collateral covered by this Financing Statemen\
t. If space in item 4 is insufficient, put the entire collateral description or continu\
ation of the
collateral description on either Addendum (Form UCC1AD) or other attac\
hed additional
pages. DO NOT
enter a social security number, employee identification number ,
or tax identification number, in any format, in box 4.
5. If filer desires (filer's option) to use titles of lessee and lessor, \
or consignee and consignor, or seller and buyer (in the case of accounts or chattel pape\
r), or bailee and
bailor instead of Debtor and Secured Party, check the appropriate box in\
item 5. If this
is an agricultural lien (as defined in applicable Commercial Code) fil\
ing or is otherwise not
a UCC security interest filing (e.g., a tax lien, judgment lien, etc.)\
, check the appropriate
box in item 5, complete items 1-7 as applicable and attach any other ite\
ms required under
other law.
6. If this Financing Statement is filed as a fixture filing or if the colla\
teral consists of timber to be cut or as-extracted collateral, complete items 1-5, check the box \
in item 6 and
UCC 201 Page 5 of 6Last Revision: 11/04/08
complete the required information (items 13, 14 and/or 15) on Addendum\
(Form UCC1AD).
7. This item is
optional
. Check appropriate box in item 7 to request Search Report(s) on all
or some of the Debtors named in this Financing Statement. The Report wi\
ll list all
Financing Statements on file against the designated Debtor on the date o\
f the report,
Including this Financing Statement. There is an additional fee for each\
Report.
If you have checked a box in item 7, file Search Report Copy together wi\
th Filing Officer
Copy (and acknowledgment Copy).
8 This item is
optional
and is for filer's use only. For filer's convenience of reference, fil\
er
may enter in item 8 any identifying information (e.g., Secured Party's \
loan number,
If Debtor is decedent's estate, law firm file number, Debtor's name or o\
ther identification,
state in which form is being filed, etc.) that filer may find useful. \
DO NOT
enter a
social security number, employee identification number, or tax Identific\
ation
number, in any format, in box 8.
Note : If Debtor is a trust or a trustee acting with respect to property hel\
d in trust, enter Debtor's name in item 1 and attach
Addendum (FormUCC1AD) and check appropriate box in item 17. If Debto\
r is decendent's estate, enter name of
deceased individual in item 1b and attach Addendum (Form UCC1AD) and c\
heck appropriate box in item 17. If Debtor is a
transmitting utility or this Financing Statement is filed in connection \
with a Manufactured Home Transaction or a
Public-Finance Transaction as defined in applicable Commercial Code, att\
ach Addendum (Form UCC1AD) and check
appropriate box in item 18.
9. Insert name of first Debtor shown on Financing Statement to which this A\
ddendum is related, exactly as shown in item 1 of Financing Statement.
10. Miscellaneous
: Under certain circumstances, additional information not provided
on Financing Statement may be required. Use this space to provide such \
additional
information or to comply with such requirements; otherwise, leave blank.\
UCC 201 Page 5 of 6Last Revision: 11/04/08
11. If this Addendum adds an additional Debtor, complete item 11 in accordan\
ce with instruction 1 on Financing Statement. To include further additional Debtors, attach\
either an additional
Addendum (Form UCC1AD) or Additional Party (Form UCC1AP) and follow \
instruction 1 of
Financing Statement for entering additional names.
12. If this Addendum adds an additional Secured Party, complete item 12 in a\
ccordance with instruction 3 of Financing Statement. To include further additional Sec\
ured Parties,
attach either an additional Addendum (Form UCC1AD) or Additional Party\
(Form UCC1AP)
and follow instruction 1 of Financing Statement for determining and form\
atting additional
names. In the case of a total assignment of the Secured Party's interes\
t before the
filing of this Financing Statement, if filer has given the name and addr\
ess of the Total
Assignee in item 3 of Financing Statement, filer may give the Assignor t\
he
Secured Party's (S/P's) name and address in item 12.
13-15 If collateral is timber to be cut or as-extracted collateral, or if this\
Financing Statement is filed as a fixture filing, check appropriate box in item 13; provide de\
scription of real
estate in item 14; and, if Debtor is not a record owner of the describe\
d real estate, also
provide, in item 15, the name and address of a record owner. Provide col\
lateral
description in item 4 of Financing Statement. Check box 6 on Financing \
Statement.
Description of real estate must be sufficient under the applicable law o\
f the jurisdiction
where the real estate is located.
16. Use this space to provide continued description of collateral, if you ca\
nnot complete description in item 4 of Financing Statement. DO NOT
enter a social security
number, employee identification number, or tax identification number, in\
any format, in box 16.
UCC 201 Page 6 of 6Last Revision: 11/04/08
17. If Debtor is a trust or a trustee acting with respect to property held i\
n trust or is a
decendent's estate, check the appropriate box.
18. If Debtor is a transmitting utility or if the Financing Statement relate\
s to a Manufactured-Home Transaction or a Public-Finance Transaction as defined in the applicable\
Commercial Code, check
the appropriate box.
19. Insert name of first Debtor shown on Financing Statement to which this A\
dditional Party relates, exactly as shown in item 1 of Financing Statement.
20. Miscellaneous
: Under certain circumstances, additional information not provided on F\
inancing
Statement may be required. Also, some states have non-uniform requireme\
nts. Use this space to
provide such additional information or to comply with such requirements;\
otherwise, leave blank.
21-23 If this Additional Party adds additional Debtors, complete items 21, 22,\
and 23 in accordance with instruction 1 of Financing Statement and give complete information for e\
ach additional Debtor. Be
sure to complete either the or
ganization's nam eor individual's name item.
24-25 If this Additional Party adds additional Secured Parties, complete items\
24 and 25 in accordance with instruction 3 of Financing Statement and give complete information \
for each additional
Secured Party.
UCC 201 Page 6 of 6Last Revision: 11/04/08