B. E-MAIL CONTACT AT FILER (optional)
SOUTH CAROLINA SECRETARY OF STATE'S OFFICE, 1205 Pendleton Street, Suite 525, Columbia, SC 29201 7/1/2013
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
UCC FINANCING STATEMENT UCC-1
FOLLOW INSTRUCTIONS
A. NAME & PHONE OF CONTACT AT FILER (optional)
OR
1a. ORGANIZATION'S NAME
POSTAL CODE
CITY1c. MAILING ADDRESS
1b. INDIVIDUAL'S SURNAME
STATE COUNTRY
8. OPTIONAL FILER REFERENCE DATA:
A Debtor is a Transmitting UtilityManufactured-Home TransactionPublic-Finance Transaction
6a. Check only if applicable and check only one box:
7. ALTERNATIVE DESIGNATION (if applicable): Seller/Buyer Bailee/BailorConsignee/ConsignorLessee/Lessor
Agricultural Lien Non-UCC Filing
OR
3b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME
POSTAL CODE
3c. MAILING ADDRESS
CITY
ADDITIONAL NAME(S)/INITIAL(S)
STATE
SUFFIX
COUNTRY
3a. ORGANIZATION'S NAME
3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only one Secured Party name (3a or 3b)
4. COLLATERAL: This financing statement covers the following collateral:
C. SEND ACKNOWLEDGMENT TO: (Name and Address)
6b. Check only if applicable and check only one box:
Licensee/Licensor
Collateral is5. Check only if applicable and check only one box:
held in a Trust (see UCC1Ad, item 17 and Instructions)
being administered by a Decedent’s Personal Representative
OR
2a. ORGANIZATION'S NAME
POSTAL CODECITY2c. MAILING ADDRESS
2b. INDIVIDUAL'S SURNAME
STATE
SUFFIX
COUNTRY
FIRST PERSONAL NAME
ADDITIONAL NAME(S)/INITIAL(S)
SUFFIX
ADDITIONAL NAME(S)/INITIAL(S)
FIRST PERSONAL NAME
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 fit 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)
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 fit 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)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11. ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b)
12. ADDITIONAL SPACE FOR ITEM 4 (Collateral):
OR
UCC FINANCING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS
9. NAME OF FIRST DEBTOR: Same as line 1a or 1b on Financing Statement; if line 1b was left blank
because Individual Debtor name did not fit, check here
9a. ORGANIZATION'S NAME
9b. INDIVIDUAL'S SURNAME
ADDITIONAL NAME(S)/INITIAL(S)
FIRST PERSONAL NAME
10. DEBTOR'S NAME: Provide (10a or 10b) only one additional Debtor name or Debtor name that did not fit in line 1b or 2b of the Financing Statement (Form UCC1) (use exact, full name;
do not omit, modify, or abbreviate any part of the Debtor’s name) and enter the mailing address in line 10c
OR
10a. ORGANIZATION'S NAME
10b. INDIVIDUAL'S SURNAME
OR
11b. INDIVIDUAL'S SURNAME
FIRST PERSONAL NAME
POSTAL CODE
11c. MAILING ADDRESS CITY
ADDITIONAL NAME(S)/INITIAL(S)
STATE
SUFFIX
COUNTRY
11a. ORGANIZATION'S NAME
17. MISCELLANEOUS:
SUFFIX
16. Description of real estate:
POSTAL CODE
CITY
10c. MAILING ADDRESS
INDIVIDUAL’S FIRST PERSONAL NAME
INDIVIDUAL’S ADDITIONAL NAME(S)/INITIAL(S)
STATE
SUFFIX
COUNTRY
15. Name and address of a RECORD OWNER of real estate described in item 16
(if Debtor does not have a record interest):
14. This FINANCING STATEMENT:
covers timber to be cut
covers as-extracted collateral
This FINANCING STATEMENT is to be filed [for record] (or recorded) in the
REAL ESTATE RECORDS (if applicable)
13.
is filed as a fixture filing
UCC-1
Ad
SOUTH CAROLINA SECRETARY OF STATE'S OFFICE, 1205 Pendleton Street Suite 525 Columbia, SC 29201
(Rev. 07/01/13)
Instructions for UCC Financing Statement (Form UCC1)
Please type or laser-print this form. Be sure it is completely legible. Read and follow all Instructions, especially Instruction 1; use of the correct name
for the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give
legal advice.
Send completed form and any attachments to the filing office, with the required fee.
ITEM INSTRUCTIONS
A and B. To assist filing offices that might wish to communicate with filer, filer may provide information in item A and item B. These items are optional.
C. Complete item C if filer desires an acknowledgment sent to them. If filing in a filing office that returns an acknowledgment copy furnished by filer,
present simultaneously with this form the Acknowledgment Copy or a carbon or other copy of this form for use as an acknowledgme nt copy.
1. Debtor’s name. Carefully review applicable statutory guidance about providing the debtor’s name. Enter only one Debtor name in item 1 -- either
an organization's name (1a)
or an individual’s name (1b). If any part of the Individual Debtor’s name will not fit in line 1b, check the box in item 1,
leave all of item 1 blank, check the box in item 9 of the Financing Statement Addendum (Form UCC1Ad) and enter the Individual Debtor name in
item 10 of the Financing Statement Addendum (Form UCC1Ad). Enter Debtor’s c
orrect name. Do not abbreviate words that are not already
abbreviated in the Debtor’s name. If a portion of the Debtor’s name consists of only an initial or an abbreviation rather than a full word, enter only
the abbreviation or the initial. If the collateral is held in a trust and the Debtor name is the name of the trust, enter trust name in the Organization’s
Name box in item 1a.
1a.
Organization Debtor Name. “Organization Name” means the name of an entity that is not a natural person. A sole proprietorship is not an
organization, even if the individual proprietor does business under a trade name. If Debtor is a registered organization (e.g., corporation, limited
partnership, limited liability company), it is advisable to examine Debtor’s current filed public organic records to determine Debtor's correct name.
Trade name is insufficient. If a corporate ending (e.g., corporation, limited partnership, limited liability company) is part of the Debtor’s name, it must
be included. Do not use words that are not part of the Debtor’s name.
1b. Individual Debtor Name. “Individual Name” means the name of a natural person; this includes the name of an individual doing business as a sole
proprietorship, whether or not operating under a trade name. The term includes the name of a decedent where collateral is being administered by
a personal representative of the decedent. The term does not include the name of an entity, even if it contains, as part of the entity’s name, the
name of an individual. Prefixes (e.g., Mr., Mrs., Ms.) and titles (e.g., M.D.) are generally not part of an individual name. Indications of lineage (e.g.,
Jr., Sr., III) generally are not part of the individual’s name, but may be entered in the Suffix box. Enter individual Debtor’s surname (family name)
in Individual’s Surname box, first personal name in First Personal Name box, and all additional names in Additional Name(s)/Initial(s) box.
If a Debtor’s name consists of only a single word, enter that word in Individual’s Surname box and leave other boxes blank.
For both organization and individual Debtors. Do not use Debtor’s trade name, DBA, AKA, FKA, division name, etc. in place of or combined with
Debtor’s correct name; filer may add such other names as additional Debtors if desired (but this is neither required nor recommended).
1c. Enter a mailing address for the Debtor named in item 1a or 1b.
2. Additional Debtor’s name. If an additional Debtor is included, complete item 2, determined and formatted per Instruction 1. For additional Debtors,
attach Addendum (Form UCC1Ad) and follow Instruction 1 for determining and formatting additional names.
3. Secured Party’s name. Enter name and mailing address for Secured Party or Assignee who will be the Secured Party of record. For additional
Secured Parties, attach Addendum (Form UCC1Ad). If there has been a full assignment of the initial Secured Party’s right to be Secured Party
of record before filing this form, either (1) enter Assignor Secured Party‘s name and mailing address in item 3 of this form and file an Amendment
(Form UCC3) [see item 5 of that form]; or (2) enter Assignee’s name and mailing address in item 3 of this form and, if desired, also attach
Addendum (Form UCC1Ad) giving Assignor Secured Party’s name and mailing address in item 11.
4. Collateral. Use item 4 to indicate the collateral covered by this financing statement. If space in item 4 is insufficient, continue the collateral
description in item 12 of the Addendum (Form UCC1Ad) or attach additional page(s) and incorporate by reference in item 12 (e.g., See Exhibit A).
Do not include social security numbers or other personally identifiable information.
Note: If this financing st atement covers timber to be cut, covers as-extracted collateral, and/or is filed as a fixture filing, attach Addendum (Form
UCC1Ad) and complete the required information in items 13, 14, 15, and 16.
5. If collateral is held in a trust or being administered by a decedent’s personal representative, check the appropriate box in item 5. If more than one
Debtor has an interest in the described collateral and the check box does not apply to the interest of all Debtors, the filer should consider filing a
separate Financing Statement (Form UCC1) for each Debtor.
6a. If this financing statement relates to a Public-Finance Transaction, Manufactured-Home Transaction, or a Debtor is a Transmitting Utility, check
the appropriate box in item 6a. If a Debtor is a Transmitting Utility and the initial financing statement is filed in connection with a Public-Finance
Transaction or Manufactured-Home Transaction, check only that a Debtor is a Transmitting Utility.
6b. If this is an Agricultural Lien (as defined in applicable state’s enactment of the Uniform Commercial Code) or if this is 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 required under other law.
7. Alternative Designation. If filer desires (at filer's option) to use the designations lessee and lessor , consignee and consignor, seller and buyer
(such as in the case of the sale of a payment intangible, promissory note, account or chattel paper), 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. For filer's convenience of reference, filer may enter in item 8 any
identifying information that filer may find useful. Do not include social security numbers or other personally identifiable information.
Instructions for UCC Financing Statement Addendum (Form UCC1Ad)
Please type or laser-print this form. Be sure it is completely legible. Read and follow all Instructions; use of the correct name for the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give
legal advice.
ITEM INSTRUCTIONS
9. Name of first Debtor. Enter name of first Debtor exactly as shown in item 1 of Financing Statement (Form UCC1) to which this Addendum relates.
The name will not be indexed as a separate debtor. The Debtor name in this section is intended to cross-reference this Addendum with the related
Financing Statement (Form UCC1).
If the box in item 1 of the Financing Statement (Form UCC1) was checked because Individual Debtor name did not fit, the box in item 9 of this
Addendum should be checked.
10. Additional Debtor’s name. If this Addendum adds an additional Debtor, complete item 10 in accordance with Instruction 1 of Financing
Statement (Form UCC1). For additional Debtors, attach either an additional Addendum or Additional Party (Form UCC1AP) and follow Instruction
1 of Financing Statement (Form UCC1) for determining and formatting additional names.
11. Additional Secured Party’s name or Assignor Secured Party’s name. If this Addendum adds an additional Secured Party, complete item 11
in accordance with Instruction 3 of Financing Statement (Form UCC1). For additional Secured Parties, attach an Addendum and complete
applicable items in accordance with Instruction 3 of Financing Statement (Form UCC1). In the case of a full assignment of the Secured Party’s
interest before the filing of this financing statement, if filer has provided the name and mailing address of the Assignee in item 3 of Financing
Statement (Form UCC1), filer may enter Assignor Secured Party’s name and mailing address in item 11.
12. Additional Collateral Description. If space in item 4 of Financing Statement (Form UCC1) is insufficient or additional information must be
provided, enter additional information in item 12 or attach additional page(s) and incorporate by reference in item 12 (e.g., See Exhibit A). Do
not include social security numbers or other personally identifiable information.
13-16. Real Estate Record Information. If this Financing Statement is to be filed in the real estate records and covers timber to be cut, covers as-
extracted collateral, and/or is filed as a fixture filing, complete items 1-4 of the Financing Statement (Form UCC1), check the box in item 13, check
the appropriate box in item 14, and complete the required information in items 15 and 16. If the Debtor does not have an interest of record, enter
the name and address of the record owner in item 15. Provide a sufficient description of real estate in accordance with the applicable law of the
jurisdiction where the real estate is located in item 16. If space in items 15 or 16 is insufficient, attach additional page(s) and incorporate by
reference in items 15 or 16 (e.g., See Exhibit A), and continue the real estate record information. Do not include social security numbers or other
personally identifiable information.
17. Miscellaneous. Under certain circumstances, additional information not provided on the Financing Statement (Form UCC1) may be required.
Also, some states have non-uniform requirements. Use this space or attach additional page(s) and incorporate by reference in item 17 (e.g., See
Exhibit A) to provide such additional information or to comply with such requirements; otherwise, leave blank. Do not include social security
numbers or other personally identifiable information.