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Fillable Printable UCC Financing Statement

Fillable Printable UCC Financing Statement

UCC Financing Statement

UCC Financing Statement

UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (font and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
     
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
     
     
     
     
     
     
     
     
     
     
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1. DEBTOR’S EXACT FULL LEGAL NAME – insert only one debtor name (1a or 1b) – do not abbreviate or combine names
OR
1a. ORGANIZATION’S NAME
     
1b. INDIVIDUAL’S LAST NAME
     
FIRST NAME
     
MIDDLE NAME
     
SUFFIX
     
1c. MAILING ADDRESS
     
CITY
     
STATE
     
POSTAL CODE
     
COUNTRY
     
1d. SEE INSTRUCTIONS
     
ADD’L INFO RE
ORGANIZATION
DEBTOR
1e. TYPE OF ORGANIZATION
     
1f. JURISDICTION OF ORGANIZATION
     
1g. ORGANIZATION ID#, if any
     
NONE
2. ADDITIONAL DEBTOR’S EXACT FULL LEGAL NAME – insert only one debtor name (1a or 1b) – do not abbreviate or combine names
OR
2a. ORGANIZATION’S NAME
     
2b. INDIVIDUAL’S LAST NAME
     
FIRST NAME
     
MIDDLE NAME
     
SUFFIX
     
2c. MAILING ADDRESS
     
CITY
     
STATE
     
POSTAL CODE
     
COUNTRY
     
2d. SEE INSTRUCTIONS
     
ADD’L INFO RE
ORGANIZATION
DEBTOR
2e. TYPE OF ORGANIZATION
     
2f. JURISDICTION OF
ORGANIZATION
     
2g. ORGANIZATION ID#, if any
     
NONE
3. SECURED PARTY’S NAME (or NAME of TOTAL ASSIGNEE or ASSIGNOR S/P) – insert only one secured party name (3a or 3b)
OR
3a. ORGANIZATION’S NAME
     
3b. INDIVIDUAL’S LAST NAME
     
FIRST NAME
     
MIDDLE NAME
     
SUFFIX
     
3c. MAILING ADDRESS
     
CITY
     
STATE
     
POSTAL CODE
     
COUNTRY
     
4. This FINANCING STATEMENT covers the following collateral:
     
     
     
     
     
     
     
     
     
     
     
     
5. ALTERNATIVE DESIGNATION [if applicable]: LESSEE/LESSOR CONSIGNEE/CONSIGNOR BAILEE/BAILOR SELLER/BUYOR AG. LIEN NON-UCC FILING
6.
This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL
ESTATE RECORDS. Attach Addendum [if applicable]
7. Check to REQUEST SEARCH REPORT(S) on Debtor(s)
[ADDITIONAL FEE] [optional]
All Debtors Debtor 1 Debtor 2
8. OPTIONAL FILER REFERENCE DATA
     
FILING OFFICE COPY – NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 05/22/02)
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