Fillable STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT

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STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT

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The STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT form is 1 page long and contains:

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STATE OF FLORIDA UNIFORM COMMERCIAL CODE
FINANCING STATEMENT INFORMATION FORM
A. NAME & PHONE OF PERSON FILING THIS STATEMENT [optional]
B. Email Address
C. SEND ACKNOWLEDGEMENT TO: (Name and Address)
Name
Address
Address
City/State/Zip
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1. INITIAL FINANCING STATEMENT FILE # This space is not available
2. CURRENT RECORD INFORMATION – DEBTOR NAME – INSERT ONLY ONE DEBTOR NAME (2a OR 2b)
2a. ORGANIZATION’S NAME
2b. INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIALS(S) SUFFIX
3. CURRENT RECORD INFORMATION – SECURED PARTY NAME – INSERT ONLY ONE SECURED PARTY NAME (3a OR 3b)
3a. ORGANIZATION’S NAME
3b. INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIALS(S) SUFFIX
4a. RECORD is inaccurate
Provide the basis for the belief of the person identified in item 6 that the RECORD identified in item 1 is inaccurate and indicate the manner in which the
person believes the RECORD should be amended to cure the inaccuracy.
4b. RECORD was wrongfully filed
Provide the basis for the belief of the person identified in item 6 that the RECORD identified in item 1 was wrongfully filed.
4c. RECORD FILED BY PERSON NOT ENTITLED TO DO SO
Provide the basis for the belief by the Secured Party of Record that the person that filed the RECORD identified in item 1 was not entitled to do so under
UCC Section 9-509
5. If this INFORMATION STATEMENT relates to a RECORD filed [or recorded] in a filing office described in s. 679.5011 F.S. and this INFORMATION STATEMENT is
filed in such a filing office, provide the date [and time] on which the INITIAL FINANCING STATEMENT identified in item 1b above was filed [or recorded].
5a. DATE
5b. TIME
6. NAME OF PERSON AUTHORIZING THE FILING OF THIS INFORMATION STATEMENT – the RECORD identified in item 1 must be indexed under this name
Or
6a. ORGANIZATION’S NAME
6b. INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIALS(S) SUFFIX
STANDARD FORM – FORM UCC-5 (REVISED 06/2013) Filing Office Copy Approved by the Secretary of State, State of Florida
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STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT

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Completed 13 April 2022

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