STATE OF FLORIDA UNIFORM COMMERCIAL CODE
FINANCING STATEMENT AMENDMENT FORM
A. NAME & DAYTIME PHONE NUMBER OF CONTACT PERSON
Email Address
B. SEND ACKNOWLEDGEMENT TO:
Name
Address
Address
City/State/Zip
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1a. INITIAL FINANCING STATEMENT FILE # 1b. This FINANCING STATEMENT AMENDMENT is to be filed
[for record] (or recorded) in the REAL ESTATE RECORDS.
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)/INITIAL(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)/INITIAL(S) SUFFIX
4. TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of the Secured Party
authorizing this Termination Statement
.
5. CONTINUATION: Effectiveness of the Financing Statement identified above with respect to security interest(s) of the Secured Party authorizing
this Continuation Statement is continued for the additional period provided by applicable law.
6. ASSIGNMENT
Full or Partial: Give name of assignee in item 9a or 9b and address of assignee in item 9c; and also give name of assignor in item 11.
7. AMENDMENT (PARTY INFORMATION): This Amendment affects Debtor or Secured Party of record. Check only one of these two boxes.
Also check one of the following three boxes and provide appropriate information in items 8 and/or 9.
CHANGE name and/or address: Give current record name in item 8a or 8b; DELETE name: Give record name ADD name: Complete item 9a or 9b,
Also give new name (if name change) in item 9a or 9b and/or new address to be deleted in item 8a or 8b. and 9c.
(if address change) in item 9c.
8. CURRENT RECORD INFORMATION
– INSERT ONLY ONE NAME (8a OR 8b) – Do Not Abbreviate or Combine Names
8a. ORGANIZATION’S NAME
8b. INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX
9. CHANGED (NEW) OR ADDED INFORMATION: – INSERT ONLY ONE NAME (9a OR 9b) – Do Not Abbreviate or Combine Names
9.a ORGANIZATION’S NAME
9.b INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX
9.c MAILING ADDRESS Line One
This space not available.
MAILING ADDRESS Line Two
CITY STATE POSTAL CODE COUNTRY
10. AMENDMENT (COLLATERAL CHANGE): check only one box.
Describe collateral DELETE or ADD, or give entire RESTATE collateral description, or describe collateral ASSIGN collateral
11. NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT (name of assignor, if this is an Assignment). If this is an Amendment
authorized by a Debtor, which adds collateral or adds the authorizing Debtor, or if this is a Termination authorized by a Debtor, check here and enter name of DEBTOR
authorizing this Amendment.
11a. ORGANIZATION’S NAME
11b. INDIVIDUAL’S SURNAME
FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX
12. OPTIONAL FILER REFERENCE DATA
STANDARD FORM - FORM UCC-3 (REV.05/2013) Filing Office Copy Approved by the Secretary of State, State of Florida
