State Codes and Statutes

Statutes > Ohio > Title13 > Chapter1309 > 1309_521

1309.521 Uniform form of written financing statement and amendment - UCC 9-521.

(A) 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 prescribed in division (B) of section 1309.516 of the Revised Code:

UCC FINANCING STATEMENT

Follow instructions (front and back) carefully.

A. Name and 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 Number: SSN or EIN …................................

Additional information regarding organization debtor

1e1d. Type of organization ….....................................

1f1e. Jurisdiction of organization ….............................

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 Number: SSN or EIN …................................

Additional information regarding organization debtor

2e2d. Type of organization ….....................................

2f2e. Jurisdiction of organization ….............................

3. SECURED PARTY’S NAME (or name of total assignee of 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 on debtor(s)

[ADDITIONAL FEE] .......... [optional]

[ ] All debtors [ ] Debtor 1 [ ] Debtor 2

8. OPTIONAL FILER REFERENCE DATA

.................................................................

.................................................................

UCC FINANCING STATEMENT ADDENDUM

Follow instructions (front and back) carefully.

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

..................................

..................................

..................................

The above space is for filing office use only.

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 Number: SSN or EIN …...............................

Additional information regarding organization debtor

11e11d. Type of organization …....................................

11f11e. Jurisdiction of organization …............................

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 is filed as a [ ] fixture 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) 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 prescribed in division (B) of section 1309.516 of the Revised Code:

UCC FINANCING STATEMENT AMENDMENT

Follow instructions (front and back) carefully.

A. Name and phone of contact at filer (optional)

................................................................

B. Send acknowledgment to: (name and address)

..................................

..................................

..................................

The above space is for filing office use only.

1a. INITIAL FINANCING STATEMENT FILE NUMBER ….................

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 assignee in item 7a or 7b and address of assignee 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 item 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 Number: SSN or EIN …................................

Additional information regarding organization debtor

7e7d. Type of organization ….....................................

7f7e. Jurisdiction of organization ….............................

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 that 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

.................................................................

UCC FINANCING STATEMENT AMENDMENT ADDENDUM

Follow instructions (front and back) carefully.

11. INITIAL FINANCING STATEMENT FILE NUMBER (same as item 1a on amendment form) .............................................

12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on amendment form)

12a. Organization’s name

.................................or

12b. Individual’s last name

.................................

First name …...................

Middle name …....... Suffix …

The above space is for filing office use only.

13. Use this space for additional information.

...................................................................

...................................................................

...................................................................

...................................................................

Effective Date: 07-01-2001; 03-30-2006

State Codes and Statutes

Statutes > Ohio > Title13 > Chapter1309 > 1309_521

1309.521 Uniform form of written financing statement and amendment - UCC 9-521.

(A) 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 prescribed in division (B) of section 1309.516 of the Revised Code:

UCC FINANCING STATEMENT

Follow instructions (front and back) carefully.

A. Name and 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 Number: SSN or EIN …................................

Additional information regarding organization debtor

1e1d. Type of organization ….....................................

1f1e. Jurisdiction of organization ….............................

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 Number: SSN or EIN …................................

Additional information regarding organization debtor

2e2d. Type of organization ….....................................

2f2e. Jurisdiction of organization ….............................

3. SECURED PARTY’S NAME (or name of total assignee of 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 on debtor(s)

[ADDITIONAL FEE] .......... [optional]

[ ] All debtors [ ] Debtor 1 [ ] Debtor 2

8. OPTIONAL FILER REFERENCE DATA

.................................................................

.................................................................

UCC FINANCING STATEMENT ADDENDUM

Follow instructions (front and back) carefully.

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

..................................

..................................

..................................

The above space is for filing office use only.

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 Number: SSN or EIN …...............................

Additional information regarding organization debtor

11e11d. Type of organization …....................................

11f11e. Jurisdiction of organization …............................

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 is filed as a [ ] fixture 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) 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 prescribed in division (B) of section 1309.516 of the Revised Code:

UCC FINANCING STATEMENT AMENDMENT

Follow instructions (front and back) carefully.

A. Name and phone of contact at filer (optional)

................................................................

B. Send acknowledgment to: (name and address)

..................................

..................................

..................................

The above space is for filing office use only.

1a. INITIAL FINANCING STATEMENT FILE NUMBER ….................

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 assignee in item 7a or 7b and address of assignee 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 item 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 Number: SSN or EIN …................................

Additional information regarding organization debtor

7e7d. Type of organization ….....................................

7f7e. Jurisdiction of organization ….............................

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 that 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

.................................................................

UCC FINANCING STATEMENT AMENDMENT ADDENDUM

Follow instructions (front and back) carefully.

11. INITIAL FINANCING STATEMENT FILE NUMBER (same as item 1a on amendment form) .............................................

12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on amendment form)

12a. Organization’s name

.................................or

12b. Individual’s last name

.................................

First name …...................

Middle name …....... Suffix …

The above space is for filing office use only.

13. Use this space for additional information.

...................................................................

...................................................................

...................................................................

...................................................................

Effective Date: 07-01-2001; 03-30-2006


State Codes and Statutes

State Codes and Statutes

Statutes > Ohio > Title13 > Chapter1309 > 1309_521

1309.521 Uniform form of written financing statement and amendment - UCC 9-521.

(A) 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 prescribed in division (B) of section 1309.516 of the Revised Code:

UCC FINANCING STATEMENT

Follow instructions (front and back) carefully.

A. Name and 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 Number: SSN or EIN …................................

Additional information regarding organization debtor

1e1d. Type of organization ….....................................

1f1e. Jurisdiction of organization ….............................

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 Number: SSN or EIN …................................

Additional information regarding organization debtor

2e2d. Type of organization ….....................................

2f2e. Jurisdiction of organization ….............................

3. SECURED PARTY’S NAME (or name of total assignee of 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 on debtor(s)

[ADDITIONAL FEE] .......... [optional]

[ ] All debtors [ ] Debtor 1 [ ] Debtor 2

8. OPTIONAL FILER REFERENCE DATA

.................................................................

.................................................................

UCC FINANCING STATEMENT ADDENDUM

Follow instructions (front and back) carefully.

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

..................................

..................................

..................................

The above space is for filing office use only.

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 Number: SSN or EIN …...............................

Additional information regarding organization debtor

11e11d. Type of organization …....................................

11f11e. Jurisdiction of organization …............................

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 is filed as a [ ] fixture 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) 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 prescribed in division (B) of section 1309.516 of the Revised Code:

UCC FINANCING STATEMENT AMENDMENT

Follow instructions (front and back) carefully.

A. Name and phone of contact at filer (optional)

................................................................

B. Send acknowledgment to: (name and address)

..................................

..................................

..................................

The above space is for filing office use only.

1a. INITIAL FINANCING STATEMENT FILE NUMBER ….................

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 assignee in item 7a or 7b and address of assignee 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 item 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 Number: SSN or EIN …................................

Additional information regarding organization debtor

7e7d. Type of organization ….....................................

7f7e. Jurisdiction of organization ….............................

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 that 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

.................................................................

UCC FINANCING STATEMENT AMENDMENT ADDENDUM

Follow instructions (front and back) carefully.

11. INITIAL FINANCING STATEMENT FILE NUMBER (same as item 1a on amendment form) .............................................

12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on amendment form)

12a. Organization’s name

.................................or

12b. Individual’s last name

.................................

First name …...................

Middle name …....... Suffix …

The above space is for filing office use only.

13. Use this space for additional information.

...................................................................

...................................................................

...................................................................

...................................................................

Effective Date: 07-01-2001; 03-30-2006