Free ra9_ucc_N3.p65 - Idaho

Mail to:

Secretary of State UCC Division 450 N 4th 700 W Jefferson PO Box 83720 Boise ID 83720-0080

Telephone: 208-334-3191 Fax: 208-334-2847

Instructions: 1. Please type and sign this form in black. 2. File only the original. Make copies for your file. The original will be returned as your acknowledgment. 3. Enter only one debtor's name or assumed name per debtor block exactly as it is to be indexed. If more than four names, use an attached sheet. Enter individual debtor names: Last, First Middle Title; e.g. Smith, John Alan Jr. 4. Be sure to correctly enter the UCC-1 Financing Statement number assigned by the filing officer. 5. One or more transactions may be made by a UCC-3. Check the appropriate boxes.

Name or business name of each debtor against whom the lien is claimed, and the address of each.

1 2 3 4

Organization or Indiv. Last Name

First Name

This block for Filing Office use only.

STATE OF IDAHO - COUNTY MEDICAL - STATEMENT OF CONTINUATION, AMENDMENT, ETC. - FORM N3

Middle Name State Zip

Suffix

Address

City

Organization or Indiv. Last Name

First Name

Middle Name

Suffix

Address Organization or Indiv. Last Name

City

State Middle Name

Zip

First Name City

Suffix Zip

Address

State

Organization or Indiv. Last Name

First Name

Middle Name

Suffix

Address

City

State

Zip

Secured Party or Asignee of Record Name and Address
Organization or Indiv. Last Name Address First Name City Middle Name State Zip

Acknowledgement Name and Address, if not Secured Party
Organization or Indiv. Last Name First Name Middle Name

Address

City

State

Zip

New Asignee Name and Address
Organization or Indiv. Last Name First Name City Middle Name State Zip

Address

Amendment or release information:

This statement refers to UCC-1 financing statement file Filed on: (month/day/year) number:

CONTINUATION. The original financing statement bearing file number shown above is still effective. TERMINATION. Secured party no longer claims a security interest under the financing statement bearing file number shown above. ASSIGNMENT. The secured party's right under the financing statement bearing file number shown above has been assigned to the assignee shown below. AMENDMENT. Financing statement bearing file number shown above is amended as set forth below. RELEASE. Secured party releases the collateral described below from the financing statement bearing the file number shown above.

Signature of Secured Party or Assignee of Record:
Rev. 07/2001