CORRECTION STATEMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY A. NAME & PHONE OF PERSON FILING THIS STATEMENT [optional] B. SEND ACKNOWLEDGMENT TO: (Name and Address)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1. Identification of the RECORD to which this CORRECTION STATEMENT relates.
1a. TYPE OF RECORD 1b. FILE # OF INITIAL FINANCING STATEMENT
2a.
RECORD is inaccurate. Provide the basis for the belief of the person identified in item 4 that the RECORD identified in item 1 is inaccurate and indicate the manner in which the person believes the RECORD should be amended to cure the inaccuracy.
2b.
RECORD was wrongfully filed. Provide the basis for the belief of the person identified in item 4 that the RECORD identified in item 1 was wrongfully filed.
3. If this CORRECTION STATEMENT relates to a RECORD filed [or recorded] in a filing office described in Section 9-501(a)(1) and this CORRECTION STATEMENT is filed in such a filing office,
provide the date [and time] on which the INITIAL FINANCING STATEMENT identified in item 1b above was filed [or recorded]. 3a. DATE 3b. TIME
4. NAME OF PERSON AUTHORIZING THE FILING OF THIS CORRECTION STATEMENT The RECORD identified in item 1 must be indexed under this name.
4a. ORGANIZATION'S NAME
OR
4b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
FILING OFFICE COPY NATIONAL CORRECTION STATEMENT (FORM UCC5) (REV. 05/01/01)
FORM SHOULD BE TYPEWRITTEN OR COMPUTER GENERATED
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