Uniform form of written financing statement and amendment.
(a) Initial financing statement form. A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in Section 7-9A-516(b):
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front 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
1a. ORGANIZATION'S NAME ___________
or
1b. INDIVIDUAL'S LAST NAME _________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
1c. MAILING ADDRESS ____________________
CITY _______________
STATE __
POSTAL CODE _______
COUNTRY ___________
1d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
1e. TYPE OF ORGANIZATION ___________
1f. JURISDICTION OF ORGANIZATION ___________
1g. ORGANIZATIONAL ID #, if any _______ NONE ___
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - Insert only one debtor name (2a or 2b) - do not abbreviate or combine names
2a. ORGANIZATION'S NAME ____________
or
2b. INDIVIDUAL'S LAST NAME __________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
2c. MAILING ADDRESS __________________
CITY _______________
STATE __
POSTAL CODE _______
COUNTRY ___________
2d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ________
2e. TYPE OF ORGANIZATION ___________
2f. JURISDICTION OF ORGANIZATION ___________
2g. ORGANIZATIONAL 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)
3a. ORGANIZATION'S NAME ___________
or
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/BUYER ___________
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
9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME ________________
or
9b. INDIVIDUAL'S LAST NAME ______________
FIRST NAME ___________
MIDDLE NAME, SUFFIX ____________
10. MISCELLANEOUS:
____________________
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - Insert only one name (11a or 11b) - do not abbreviate or combine names
11a. ORGANIZATION'S NAME _______________
or
11b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
11c. MAILING ADDRESS ____________________
CITY _______________
STATE ___
POSTAL CODE _______
COUNTRY ___________
11d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
11e. TYPE OF ORGANIZATION ___________
11f. JURISDICTION OF ORGANIZATION ___________
11g. ORGANIZATIONAL ID #, if any _______ NONE ___
12. ADDITIONAL SECURED PARTY'S
or
ASSIGNOR S/P'S NAME - Insert only one name (12a or 12b)
12a. ORGANIZATION'S NAME _______________
or
12b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME ________
SUFFIX _____
12c. MAILING ADDRESS ____________________
CITY ____________
STATE ___
POSTAL CODE _______
COUNTRY ___________
13. This FINANCING STATEMENT covers ____ timber to be cut or ____ as extracted collateral, or be filed as a ____ future filing.
14. Description of real estate
____________________
____________________
15. Name and address of a RECORD OWNER of above described real estate (if Debtor does not have a record interest):
____________________
16. Additional collateral description:
____________________
17. Check only if applicable and check only one box.
Debtor is a _____ Trust or _____ Trustee acting with respect to property held in trust or _____ Decedent's Estate
18. Check only if applicable and check only one box.
______ Debtor is a TRANSMITTING UTILITY
______ Filed in connection with a Manufactured Home Transaction-effective 30 years
______ Filed in connection with a Public Finance Transaction-effective 30 years
(b) Amendment form. A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in Section 7-9A-516(b):
UCC FINANCING STATEMENT AMENDMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER ___________ (optional)
B. SEND ACKNOWLEDGMENT TO: ___________ (Name and Address)
1a. INITIAL FINANCING STATEMENT FILE #
1b. This FINANCING STATEMENT AMENDMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS.
2. _____ TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of the Secured Party authorizing this Termination Statement.
3. _____ 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.
4. _____ ASSIGNMENT (full or partial): Give name of consignee in box 7a or 7b and address of consignee in item 7c, and also give name of assignor in Item 9.
5. 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 6 and/or 7.
_____ CHANGE name and/or address: Give current record name in Item 6a or 6b; also give new name (if name change) in Items 7a or 7b and/or new address (if address change) in Item 7c.
_____ DELETE name. Give record name to be deleted in Item 6a or 6b.
_____ ADD name. Complete Item 7a or 7b, and also Item 7c; also complete Items 7d-7g (if applicable).
6. CURRENT RECORD INFORMATION
6a. ORGANIZATION'S NAME _______________
or
6b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
7. CHANGED (NEW) OR ADDED INFORMATION:
7a. ORGANIZATION'S NAME _______________
or
7b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
7c. MAILING ADDRESS ____________________
CITY _______________
STATE ___
POSTAL CODE _______
COUNTRY ___________
7d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
7e. TYPE OF ORGANIZATION ___________
7f. JURISDICTION OF ORGANIZATION ___________
7g. ORGANIZATIONAL ID #, if any ________ NONE ____
8. AMENDMENT (COLLATERAL CHANGE): Check only one box.
Describe collateral _____ deleted or _____ added, or give entire _____ restated collateral description, or describe collateral ______ assigned.
____________________
____________________
9. 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.
9a. ORGANIZATION'S NAME _______________
or
9b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
10. OPTIONAL FILER REFERENCE DATA
____________________
11. INITIAL FINANCING STATEMENT FILE # (same as Item 1a on Amendment form) __________________
12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as Item 8 on Amendment form)
Uniform form of written financing statement and amendment.
(a) Initial financing statement form. A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in Section 7-9A-516(b):
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front 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
1a. ORGANIZATION'S NAME ___________
or
1b. INDIVIDUAL'S LAST NAME _________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
1c. MAILING ADDRESS ____________________
CITY _______________
STATE __
POSTAL CODE _______
COUNTRY ___________
1d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
1e. TYPE OF ORGANIZATION ___________
1f. JURISDICTION OF ORGANIZATION ___________
1g. ORGANIZATIONAL ID #, if any _______ NONE ___
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - Insert only one debtor name (2a or 2b) - do not abbreviate or combine names
2a. ORGANIZATION'S NAME ____________
or
2b. INDIVIDUAL'S LAST NAME __________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
2c. MAILING ADDRESS __________________
CITY _______________
STATE __
POSTAL CODE _______
COUNTRY ___________
2d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ________
2e. TYPE OF ORGANIZATION ___________
2f. JURISDICTION OF ORGANIZATION ___________
2g. ORGANIZATIONAL 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)
3a. ORGANIZATION'S NAME ___________
or
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/BUYER ___________
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
9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME ________________
or
9b. INDIVIDUAL'S LAST NAME ______________
FIRST NAME ___________
MIDDLE NAME, SUFFIX ____________
10. MISCELLANEOUS:
____________________
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - Insert only one name (11a or 11b) - do not abbreviate or combine names
11a. ORGANIZATION'S NAME _______________
or
11b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
11c. MAILING ADDRESS ____________________
CITY _______________
STATE ___
POSTAL CODE _______
COUNTRY ___________
11d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
11e. TYPE OF ORGANIZATION ___________
11f. JURISDICTION OF ORGANIZATION ___________
11g. ORGANIZATIONAL ID #, if any _______ NONE ___
12. ADDITIONAL SECURED PARTY'S
or
ASSIGNOR S/P'S NAME - Insert only one name (12a or 12b)
12a. ORGANIZATION'S NAME _______________
or
12b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME ________
SUFFIX _____
12c. MAILING ADDRESS ____________________
CITY ____________
STATE ___
POSTAL CODE _______
COUNTRY ___________
13. This FINANCING STATEMENT covers ____ timber to be cut or ____ as extracted collateral, or be filed as a ____ future filing.
14. Description of real estate
____________________
____________________
15. Name and address of a RECORD OWNER of above described real estate (if Debtor does not have a record interest):
____________________
16. Additional collateral description:
____________________
17. Check only if applicable and check only one box.
Debtor is a _____ Trust or _____ Trustee acting with respect to property held in trust or _____ Decedent's Estate
18. Check only if applicable and check only one box.
______ Debtor is a TRANSMITTING UTILITY
______ Filed in connection with a Manufactured Home Transaction-effective 30 years
______ Filed in connection with a Public Finance Transaction-effective 30 years
(b) Amendment form. A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in Section 7-9A-516(b):
UCC FINANCING STATEMENT AMENDMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER ___________ (optional)
B. SEND ACKNOWLEDGMENT TO: ___________ (Name and Address)
1a. INITIAL FINANCING STATEMENT FILE #
1b. This FINANCING STATEMENT AMENDMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS.
2. _____ TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of the Secured Party authorizing this Termination Statement.
3. _____ 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.
4. _____ ASSIGNMENT (full or partial): Give name of consignee in box 7a or 7b and address of consignee in item 7c, and also give name of assignor in Item 9.
5. 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 6 and/or 7.
_____ CHANGE name and/or address: Give current record name in Item 6a or 6b; also give new name (if name change) in Items 7a or 7b and/or new address (if address change) in Item 7c.
_____ DELETE name. Give record name to be deleted in Item 6a or 6b.
_____ ADD name. Complete Item 7a or 7b, and also Item 7c; also complete Items 7d-7g (if applicable).
6. CURRENT RECORD INFORMATION
6a. ORGANIZATION'S NAME _______________
or
6b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
7. CHANGED (NEW) OR ADDED INFORMATION:
7a. ORGANIZATION'S NAME _______________
or
7b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
7c. MAILING ADDRESS ____________________
CITY _______________
STATE ___
POSTAL CODE _______
COUNTRY ___________
7d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
7e. TYPE OF ORGANIZATION ___________
7f. JURISDICTION OF ORGANIZATION ___________
7g. ORGANIZATIONAL ID #, if any ________ NONE ____
8. AMENDMENT (COLLATERAL CHANGE): Check only one box.
Describe collateral _____ deleted or _____ added, or give entire _____ restated collateral description, or describe collateral ______ assigned.
____________________
____________________
9. 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.
9a. ORGANIZATION'S NAME _______________
or
9b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
10. OPTIONAL FILER REFERENCE DATA
____________________
11. INITIAL FINANCING STATEMENT FILE # (same as Item 1a on Amendment form) __________________
12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as Item 8 on Amendment form)
Uniform form of written financing statement and amendment.
(a) Initial financing statement form. A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in Section 7-9A-516(b):
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front 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
1a. ORGANIZATION'S NAME ___________
or
1b. INDIVIDUAL'S LAST NAME _________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
1c. MAILING ADDRESS ____________________
CITY _______________
STATE __
POSTAL CODE _______
COUNTRY ___________
1d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
1e. TYPE OF ORGANIZATION ___________
1f. JURISDICTION OF ORGANIZATION ___________
1g. ORGANIZATIONAL ID #, if any _______ NONE ___
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - Insert only one debtor name (2a or 2b) - do not abbreviate or combine names
2a. ORGANIZATION'S NAME ____________
or
2b. INDIVIDUAL'S LAST NAME __________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
2c. MAILING ADDRESS __________________
CITY _______________
STATE __
POSTAL CODE _______
COUNTRY ___________
2d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ________
2e. TYPE OF ORGANIZATION ___________
2f. JURISDICTION OF ORGANIZATION ___________
2g. ORGANIZATIONAL 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)
3a. ORGANIZATION'S NAME ___________
or
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/BUYER ___________
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
9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME ________________
or
9b. INDIVIDUAL'S LAST NAME ______________
FIRST NAME ___________
MIDDLE NAME, SUFFIX ____________
10. MISCELLANEOUS:
____________________
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - Insert only one name (11a or 11b) - do not abbreviate or combine names
11a. ORGANIZATION'S NAME _______________
or
11b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
11c. MAILING ADDRESS ____________________
CITY _______________
STATE ___
POSTAL CODE _______
COUNTRY ___________
11d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
11e. TYPE OF ORGANIZATION ___________
11f. JURISDICTION OF ORGANIZATION ___________
11g. ORGANIZATIONAL ID #, if any _______ NONE ___
12. ADDITIONAL SECURED PARTY'S
or
ASSIGNOR S/P'S NAME - Insert only one name (12a or 12b)
12a. ORGANIZATION'S NAME _______________
or
12b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME ________
SUFFIX _____
12c. MAILING ADDRESS ____________________
CITY ____________
STATE ___
POSTAL CODE _______
COUNTRY ___________
13. This FINANCING STATEMENT covers ____ timber to be cut or ____ as extracted collateral, or be filed as a ____ future filing.
14. Description of real estate
____________________
____________________
15. Name and address of a RECORD OWNER of above described real estate (if Debtor does not have a record interest):
____________________
16. Additional collateral description:
____________________
17. Check only if applicable and check only one box.
Debtor is a _____ Trust or _____ Trustee acting with respect to property held in trust or _____ Decedent's Estate
18. Check only if applicable and check only one box.
______ Debtor is a TRANSMITTING UTILITY
______ Filed in connection with a Manufactured Home Transaction-effective 30 years
______ Filed in connection with a Public Finance Transaction-effective 30 years
(b) Amendment form. A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in Section 7-9A-516(b):
UCC FINANCING STATEMENT AMENDMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER ___________ (optional)
B. SEND ACKNOWLEDGMENT TO: ___________ (Name and Address)
1a. INITIAL FINANCING STATEMENT FILE #
1b. This FINANCING STATEMENT AMENDMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS.
2. _____ TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of the Secured Party authorizing this Termination Statement.
3. _____ 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.
4. _____ ASSIGNMENT (full or partial): Give name of consignee in box 7a or 7b and address of consignee in item 7c, and also give name of assignor in Item 9.
5. 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 6 and/or 7.
_____ CHANGE name and/or address: Give current record name in Item 6a or 6b; also give new name (if name change) in Items 7a or 7b and/or new address (if address change) in Item 7c.
_____ DELETE name. Give record name to be deleted in Item 6a or 6b.
_____ ADD name. Complete Item 7a or 7b, and also Item 7c; also complete Items 7d-7g (if applicable).
6. CURRENT RECORD INFORMATION
6a. ORGANIZATION'S NAME _______________
or
6b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
7. CHANGED (NEW) OR ADDED INFORMATION:
7a. ORGANIZATION'S NAME _______________
or
7b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
7c. MAILING ADDRESS ____________________
CITY _______________
STATE ___
POSTAL CODE _______
COUNTRY ___________
7d. TAX ID # SSN OR EIN ____________
ADD'L INFO RE ORGANIZATION DEBTOR ____________
7e. TYPE OF ORGANIZATION ___________
7f. JURISDICTION OF ORGANIZATION ___________
7g. ORGANIZATIONAL ID #, if any ________ NONE ____
8. AMENDMENT (COLLATERAL CHANGE): Check only one box.
Describe collateral _____ deleted or _____ added, or give entire _____ restated collateral description, or describe collateral ______ assigned.
____________________
____________________
9. 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.
9a. ORGANIZATION'S NAME _______________
or
9b. INDIVIDUAL'S LAST NAME _____________
FIRST NAME ___________
MIDDLE NAME _________
SUFFIX _____
10. OPTIONAL FILER REFERENCE DATA
____________________
11. INITIAL FINANCING STATEMENT FILE # (same as Item 1a on Amendment form) __________________
12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as Item 8 on Amendment form)
