UCC FINANCING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
9a. ORGANIZATION'S NAME
9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
OR
9b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME,SUFFIX
10. MISCELLANEOUS:
Print
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
Reset
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
OR
11b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
11c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
11d. SEE INSTRUCTIONS
ADD'L INFO RE ORGANIZATION DEBTOR
11e. TYPE OF ORGANIZATION
11f. JURISDICTION OF ORGANIZATION
11g. ORGANIZATIONAL ID #, if any NONE
12.
12a. ORGANIZATION'S NAME
ADDITIONAL SECURED PARTY'S or
ASSIGNOR S/P'S NAME - insert only one name (12a or 12b)
OR
12b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
12c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
13. This FINANCING STATEMENT covers
collateral, or is filed as a fixture filing.
timber to be cut or
as-extracted
16. Additional collateral description:
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):
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
FILING OFFICE COPY UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05/22/02)
International Association of Commercial Administrators (IACA)