| | |
OR | 3b. | INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX |
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| | | ____________________________________________________________ |
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| | | 3c. | MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY |
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| | | ____________________________________________________________ |
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| | | 4. | This FINANCING STATEMENT covers the following collateral: |
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| | | ____________________________________________________________ |
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| | | 5. | ALTERNATIVE DESIGNATION [if applicable]:__[__] LESSEE/LESSOR |
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| | | [__] CONSIGNEE/CONSIGNOR [__] BAILEE/BAILOR [__] SELLER/BUYER |
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| | | [__] AG. LIEN [__] NON-UCC FILING |
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| | | 6. | [__] This FINANCING STATEMENT is to be filed (for record) |
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| | | (or recorded) in the REAL ESTATE RECORDS. |
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| | | Attach Addendum [if applicable] |
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| | | 7. | Check to REQUEST SEARCH REPORT(S) on Debtor(s) |
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| | | [__] All Debtors__[__] Debtor 1__[__] Debtor 2 |
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| | | [ADDITIONAL FEE] [optional] |
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| | | __________________________________________ |
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| | | 8. | OPTIONAL FILER REFERENCE DATA |
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| | | ____________________________________________________________ |
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| | | FILING OFFICE COPY - NATIONAL UCC FILING STATEMENT (FORM UCC 1) | | (REV. 07/29/98) |
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| | | UCC FINANCING STATEMENT ADDENDUM |
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| | | Follow instructions (front and back) CAREFULLY |
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| | | 9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING | | STATEMENT |
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