§9-1521.__Uniform form of written financing statement and

amendment

(1)__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 set forth in section 9-1516, subsection (2):

UCC FINANCING STATEMENT

FOLLOW INSTRUCTIONS (front and back) CAREFULLY

NAME AND PHONE OF CONTACT AT FILER [optional]

_________________________________________________

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

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OR 1b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

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1c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

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