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| | | ____________________________________________________________ |
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| | | OR | 12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX |
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| | | ____________________________________________________________ |
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| | | 12c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY |
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| | | ____________________________________________________________ |
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| | | This FINANCING STATEMENT covers [__] timber to be cut or [ ] | | as-extracted collateral, or is filed as a [__] fixture | | filing. |
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| | | 14. | Description of real estate: |
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| | | ____________________________________________________________ |
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| | | 15. | Name and address of a RECORD OWNER of the above-described | | real estate (if Debtor does not have record interest): |
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| | | ____________________________________________________________ |
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| | | 16. | Additional collateral description: |
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| | | ____________________________________________________________ |
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| | | 17. | Check only if applicable and check only one box: |
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| | | Debtor is a [__] Trust or [__] Trustee acting with respect | | to property held in trust or [__] Decedent's Estate |
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| | | 18. | Check only if applicable and check only one box: |
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| | | [__] Debtor is a TRANSMITTING UTILITY |
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| | | [__] Filed in connection with a Manufactured-Home | | Transaction - effective 30 years |
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| | | [__] Filed in connection with a Public-Finance Transaction - | | effective 30 years |
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| | | FILING OFFICE COPY - NATIONAL UCC FILING STATEMENT |
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