B. SEND ACKNOWLEDGMENT TO: (Name and Address)
FILING OFFICE COPY UCC FINANCING STATEMENT (FORM UCC1) (REV. 05/22/02)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (1a or 1b) - do not abbreviate or combine names
4. This FINANCING STATEMENT covers the following collateral:
COUNTRY
5. ALTERNATIVE DESIGNATION [if applicable]:
NON-UCC FILINGAG. LIENSELLER/BUYERBAILEE/BAILORCONSIGNEE/CONSIGNORLESSEE/LESSOR
This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL
ESTATE RECORDS. Attach Addendum
6.
All Debtors Debtor 1
Debtor 2
Check to REQUEST SEARCH REPORT(S) on Debtor(s)
[ADDITIONAL FEE]
7.
[if applicable] [optional]
OR
SUFFIX
POSTAL CODE
CITY
FIRST NAME
2c. MAILING ADDRESS
OR
OR
2d. SEE INSTRUCTIONS
ADD'L INFO RE
ORGANIZATION
DEBTOR
2e. TYPE OF ORGANIZATION 2f. JURISDICTION OF ORGANIZATION
3b. INDIVIDUAL'S LAST NAME
FIRST NAME
POSTAL CODE3c. MAILING ADDRESS
1a. ORGANIZATION'S NAME
2b. INDIVIDUAL'S LAST NAME
CITY
MIDDLE NAME
STATE
2g. ORGANIZATIONAL ID #, if any
MIDDLE NAME
STATE
SUFFIX
COUNTRY
1d. SEE INSTRUCTIONS
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (2a or 2b) - do not abbreviate or combine names
POSTAL CODECITY
1c. MAILING ADDRESS
ADD'L INFO RE
ORGANIZATION
DEBTOR
1e. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION
NONE
1b. INDIVIDUAL'S LAST NAME
2a. ORGANIZATION'S NAME
FIRST NAME
MIDDLE NAME
STATE
1g. ORGANIZATIONAL ID #, if any
SUFFIX
COUNTRY
NONE
3a. ORGANIZATION'S NAME
3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - insert only one secured party name (3a or 3b)
8.
OPTIONAL FILER REFERENCE DATA
Print
Reset
Instructions for UCC Financing Statement (Form UCC1)
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.
Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. Filing office cannot give legal advice.
Do not insert anything in the open space in the upper portion of this form; it is reserved for filing office use.
When properly completed, send Filing Office Copy, with required fee, to filing office. If you want an acknowledgment, complete item B and, if filing in a filing
office that returns an acknowledgment copy furnished by filer, you may also send Acknowledgment Copy; otherwise detach. If you want to make a search
request, complete item 7 (after reading 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 Addendum (Form UCC1Ad) or Additional Party (Form UCC1AP).
A.To assist filing offices that might wish to communicate with filer, filer may 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
simultaneously with this form a carbon or other copy of this form for use as an acknowledgment copy.
1. Debtor name: Enter only one Debtor name in item 1, an organization's
name (1a) or an individuals name (1b). Enter Debtors exact full legal
name. Dont 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 legal name of
partnership; you need not enter names of partners as additional Debtors.
If Debtor is a registered organization (e.g., corporation, limited partnership,
limited liability company), it is advisable to examine Debtors current filed
charter documents 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 other 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 given
name in First Name box, and all additional given names in Middle Name
box.
For both organization and individual Debtors: Dont use Debtors trade
name, DBA, AKA, FKA, Division name, etc. in place of or combined with
Debtors legal name; you may add such other names as additional
Debtors if you wish (but this is neither required nor recommended).
1c. An address is always required for the Debtor named in 1a or 1b.
1d. Reserved for Financing Statements to be filed in North Dakota or South
Dakota only. If this Financing Statement is to be filed in North Dakota
or South Dakota, the Debtors taxpayer identification number (tax ID#)
 social security number or employer identification number must be
placed in this box.
1e,f,g. Additional information re organization Debtor is always required.
Type of organization and jurisdiction of organization as well as
Debtors exact legal name can be determined from Debtors current
filed charter document. Organizational ID #, if any, is assigned by the
agency where the charter document was filed; this is different from
tax ID #; this should be entered preceded by the 2-character U.S.
Postal identification of state of organization if one of the United States
(e.g., CA12345, for a California corporation whose organizational ID
# is 12345); if agency does not assign organizational ID #, check box
in item 1g indicating none.
Note: If Debtor is a trust or a trustee acting with respect to property held in trust,
enter Debtor's name in item 1 and attach Addendum (Form UCC1Ad) and
check appropriate box in item 17. If Debtor is a decedent's estate, enter name
of deceased individual in item 1b and attach Addendum (Form UCC1Ad) and
check 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, attach Addendum (Form UCC1Ad) and check appropriate
box in item 18.
2. If an additional Debtor is included, complete item 2, determined and
formatted per Instruction 1. To include further additional Debtors,
attach either Addendum (Form UCC1Ad) or Additional Party (Form
UCC1AP) and follow Instruction 1 for determining and formatting
additional names.
3. Enter information for Secured Party or Total Assignee, determined and
formatted per Instruction 1. To include further additional Secured
Parties, attach either Addendum (Form UCC1Ad) or Additional Party
(Form UCC1AP) and follow Instruction 1 for determining and formatting
additional names. If there has been a total assignment of the Secured
Partys interest prior to filing this form, you may either (1) enter
Assignor S/Ps name and address in item 3 and file an Amendment
(Form UCC3) [see item 5 of that form]; or (2) enter Total Assignees
name and address in item 3 and, if you wish, also attaching Addendum
(Form UCC1Ad) giving Assignor S/Ps name and address in item 12.
4. Use item 4 to indicate the collateral covered by this Financing Statement.
If space in item 4 is insufficient, put the entire collateral description or
continuation of the collateral description on either Addendum (Form
UCC1Ad) or other attached additional page(s).
5. If filer desires (at 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 paper), 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) filing 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 items required under other law.
6. If this Financing Statement is filed as a fixture filing or if the collateral
consists of timber to be cut or as-extracted collateral, complete items 1-
5, check the box in item 6, and 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 will list all Financing Statements on file against the designated
Debtor on the date of 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 with Filing Officer Copy (and
Acknowledgment Copy). Note: Not all states do searches and not all
states will honor a search request made via this form; some states require
a separate request form.
8. 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 (e.g.,
Secured Party's loan number, law firm file number, Debtor's name or
other identification, state in which form is being filed, etc.) that filer may
find useful.
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