USE THIS FORM TO ADD NAMES ONLY (DO NOT USE FOR CHANGES, DELETIONS, OR ASSIGNMENTS) UCC FINANCING STATEMENT ADDITIONAL PARTY
FOLLOW INSTRUCTIONS (front and back) CAREFULLY 19. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
19a. ORGANIZATION'S NAME
OR
19b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME, SUFFIX
20. MISCELLANEOUS:
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21a. ORGANIZATION'S NAME
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THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 21. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one name (21a or 21b) - do not abbreviate or combine names
OR
21b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
21c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
21d. SEE INSTRUCTIONS
ADD'L INFO RE ORGANIZATION DEBTOR
21e. TYPE OF ORGANIZATION
21f. JURISDICTION OF ORGANIZATION
21g. ORGANIZATIONAL ID #, if any NONE
22. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one name (22a or 22b) - do not abbreviate or combine names
22a. ORGANIZATION'S NAME
OR
22b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
22c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
22d. SEE INSTRUCTIONS
ADD'L INFO RE ORGANIZATION DEBTOR
22e. TYPE OF ORGANIZATION
22f. JURISDICTION OF ORGANIZATION
22g. ORGANIZATIONAL ID #, if any NONE
23. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one name (23a or 23b) - do not abbreviate or combine names
23a. ORGANIZATION'S NAME
OR
23b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
23c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
23d. SEE INSTRUCTIONS
ADD'L INFO RE ORGANIZATION DEBTOR
23e. TYPE OF ORGANIZATION
23f. JURISDICTION OF ORGANIZATION
23g. ORGANIZATIONAL ID #, if any NONE
24. ADDITIONAL SECURED PARTY'S NAME (or Name of TOTAL ASSIGNEE) - insert only one name (24a or 24b)
24a. ORGANIZATION'S NAME
OR
24b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
24c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
25. ADDITIONAL SECURED PARTY'S NAME (or Name of TOTAL ASSIGNEE) - insert only one name (25a or 25b)
25a. ORGANIZATION'S NAME
OR
25b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
25c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
403 FILING OFFICE COPY -- UCC NATIONAL STATEMENT ADDITIONAL PARTY (FORM UCC1AP) (REV. 05/22/02)
Instructions for UCC Financing Statement Additional Party (Form UCC1AP)
Use this form to continue adding additional Debtor or Secured Party names as needed when filing a UCC Financing Statement (Form UCC1). 19. 20. Insert name of first Debtor shown on Financing Statement to which this Additional Party relates, exactly as shown in item 1 of Financing Statement. Miscellaneous: Under certain circumstances, additional information not provided on Financing Statement may be required. Also, some states have non-uniform requirements. Use this space to provide such additional information or to comply with such requirements; otherwise, leave blank.
20-23. If this Additional Party adds additional Debtors, complete item 21, 22, and 23 in accordance with Instruction 1 of Financing Statement and give complete information for each additional Debtor. Be sure to complete either the organization's name or individual's name items. 24-25. If this Additional Party adds additional Secured Parties, complete items 24 and 25 in accordance with Instruction 3 of Financing Statement and give complete information for each additional Secured Party. Send completed form and fee to: Secretary of State Corporation Division UCC Section 255 Capitol St. NE, Suite 151 Salem, OR 97310-1327