ucc-1 Financial Statement

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UCC FINANCING STATEMENT FOLLOW INSTRUCTIONS (front and back) CAREFULLY A. NAME & PHONE OF CONTACT AT FILER [optional] B. SEND ACKNOWLEDGMENT TO: (Name and Address) Print 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 Reset THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY OR 1b. INDIVIDUAL'S LAST NAME 1c. MAILING ADDRESS FIRST NAME MIDDLE NAME SUFFIX CITY STATE POSTAL CODE COUNTRY 1d. SEE INSTRUCTIO
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  B. SEND ACKNOWLEDGMENT TO: (Name and Address) FILING OFFICE COPY     UCC FINANCING STATEMENT (FORM UCC1) (REV. 05/22/02) THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY UCC FINANCING STATEMENT FOLLOW INSTRUCTIONS (front and back) CAREFULLY A. NAME & PHONE OF CONTACT AT FILER [optional] 1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (1a or 1b) - do not abbreviate or combine names 4. This FINANCING STATEMENT covers the following collateral : COUNTRY 5.   ALTERNATIVE DESIGNATION [if applicable]:NON-UCC FILINGAG. LIENSELLER/BUYERBAILEE/BAILORCONSIGNEE/CONSIGNORLESSEE/LESSOR This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REALESTATE RECORDS. Attach Addendum 6. All DebtorsDebtor 1Debtor 2Check to REQUEST SEARCH REPORT(S) on Debtor(s)[ADDITIONAL FEE] 7. [if applicable][optional] OR SUFFIXPOSTAL CODECITYFIRST NAME2c. MAILING ADDRESS OROR 2d. SEE INSTRUCTIONS ADD'L INFO REORGANIZATIONDEBTOR2e. TYPE OF ORGANIZATION2f. JURISDICTION OF ORGANIZATION3b. INDIVIDUAL'S LAST NAMEFIRST NAMEPOSTAL CODE3c. MAILING ADDRESS1a. ORGANIZATION'S NAME2b. INDIVIDUAL'S LAST NAMECITYMIDDLE NAMESTATE2g. ORGANIZATIONAL ID #, if anyMIDDLE NAMESTATESUFFIXCOUNTRY1d. SEE INSTRUCTIONS 2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (2a or 2b) - do not abbreviate or combine namesPOSTAL CODECITY1c. MAILING ADDRESSADD'L INFO REORGANIZATIONDEBTOR1e. TYPE OF ORGANIZATION1f. JURISDICTION OF ORGANIZATIONNONE1b. INDIVIDUAL'S LAST NAME2a. ORGANIZATION'S NAMEFIRST NAMEMIDDLE NAMESTATE1g. ORGANIZATIONAL ID #, if anySUFFIXCOUNTRYNONE3a. ORGANIZATION'S NAME 3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - insert only one secured party name (3a or 3b) 8. OPTIONAL FILER REFERENCE DATA Print Reset International Association of Commercial Administrators (IACA)  Instructions for UCC Financing Statement (Form UCC1) Please type or laser-print this form. Be sure it is completely legible. Read all Instructions, especially Instruction 1; correct Debtor name is crucial. Follow Instructions completely.Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. Filing office cannot give legal advice.Do not insert anything in the open space in the upper portion of this form; it is reserved for filing office use.When properly completed, send Filing Office Copy, with required fee, to filing office. If you want an acknowledgment, complete item B and, if filing in a filingoffice that returns an acknowledgment copy furnished by filer, you may also send Acknowledgment Copy; otherwise detach. If you want to make a searchrequest, complete item 7 (after reading Instruction 7 below) and send Search Report Copy, otherwise detach. Always detach Debtor and Secured PartyCopies.If you need to use attachments, you are encouraged to use either Addendum (Form UCC1Ad) or Additional Party (Form UCC1AP). A.To assist filing offices that might wish to communicate with filer, filer may provide information in item A. This item is optional.B.Complete item B if you want an acknowledgment sent to you. If filing in a filing office that returns an acknowledgment copy furnished by filer, presentsimultaneously with this form a carbon or other copy of this form for use as an acknowledgment copy.1. Debtor name : Enter only one Debtor name in item 1, an organization'sname (1a) or an individuals name (1b). Enter Debtors exact full legalname. Dont abbreviate.1a.Organization Debtor. Organization means an entity having a legalidentity separate from its owner. A partnership is an organization; a soleproprietorship is not an organization, even if it does business under atrade name. If Debtor is a partnership, enter exact full legal name of partnership; you need not enter names of partners as additional Debtors.If Debtor is a registered organization (e.g., corporation, limited partnership,limited liability company), it is advisable to examine Debtors current filedcharter documents to determine Debtor's correct name, organizationtype, and jurisdiction of organization.1b.Individual Debtor. Individual means a natural person; this includes asole proprietorship, whether or not operating under a trade name. Dontuse prefixes (Mr., Mrs., Ms.). Use suffix box only for titles of lineage (Jr.,Sr., III) and not for other suffixes or titles (e.g., M.D.). Use married womans personal name (Mary Smith, not Mrs. John Smith). Enterindividual Debtors family name (surname) in Last Name box, first givenname in First Name box, and all additional given names in Middle Namebox.For both organization and individual Debtors: Dont use Debtors tradename, DBA, AKA, FKA, Division name, etc. in place of or combined withDebtors legal name; you may add such other names as additionalDebtors if you wish (but this is neither required nor recommended).1c.An address is always required for the Debtor named in 1a or 1b.1d.Reserved for Financing Statements to be filed in North Dakota or SouthDakota only. If this Financing Statement is to be filed in North Dakotaor South Dakota, the Debtors taxpayer identification number (tax ID#) social security number or employer identification number must beplaced in this box.1e,f,g. Additional information re organization Debtor is always required.Type of organization and jurisdiction of organization as well asDebtors exact legal name can be determined from Debtors currentfiled charter document. Organizational ID #, if any, is assigned by theagency where the charter document was filed; this is different fromtax ID #; this should be entered preceded by the 2-character U.S.Postal identification of state of organization if one of the United States(e.g., CA12345, for a California corporation whose organizational ID# is 12345); if agency does not assign organizational ID #, check boxin item 1g indicating none. Note: If Debtor is a trust or a trustee acting with respect to property held in trust,enter Debtor's name in item 1 and attach Addendum (Form UCC1Ad) andcheck appropriate box in item 17. If Debtor is a decedent's estate, enter nameof deceased individual in item 1b and attach Addendum (Form UCC1Ad) andcheck appropriate box in item 17. If Debtor is a transmitting utility or thisFinancing Statement is filed in connection with a Manufactured-HomeTransaction or a Public-Finance Transaction as defined in applicableCommercial Code, attach Addendum (Form UCC1Ad) and check appropriatebox in item 18.2.If an additional Debtor is included, complete item 2, determined andformatted per Instruction 1. To include further additional Debtors,attach either Addendum (Form UCC1Ad) or Additional Party (FormUCC1AP) and follow Instruction 1 for determining and formattingadditional names.3.Enter information for Secured Party or Total Assignee, determined andformatted per Instruction 1. To include further additional SecuredParties, attach either Addendum (Form UCC1Ad) or Additional Party(Form UCC1AP) and follow Instruction 1 for determining and formattingadditional names. If there has been a total assignment of the SecuredPartys interest prior to filing this form, you may either (1) enter Assignor S/Ps name and address in item 3 and file an Amendment(Form UCC3) [see item 5 of that form]; or (2) enter Total Assigneesname and address in item 3 and, if you wish, also attaching Addendum(Form UCC1Ad) giving Assignor S/Ps name and address in item 12.4.Use item 4 to indicate the collateral covered by this Financing Statement.If space in item 4 is insufficient, put the entire collateral description orcontinuation of the collateral description on either Addendum (FormUCC1Ad) or other attached additional page(s).5.If filer desires (at filer's option) to use titles of lessee and lessor, orconsignee and consignor, or seller and buyer (in the case of accounts orchattel paper), or bailee and bailor instead of Debtor and Secured Party,check the appropriate box in item 5. If this is an agricultural lien (asdefined in applicable Commercial Code) filing or is otherwise not a UCCsecurity interest filing (e.g., a tax lien, judgment lien, etc.), check theappropriate box in item 5, complete items 1-7 as applicable and attach anyother items required under other law.6.If this Financing Statement is filed as a fixture filing or if the collateralconsists of timber to be cut or as-extracted collateral, complete items 1-5, check the box in item 6, and complete the required information (items13, 14 and/or 15) on Addendum (Form UCC1Ad).7.This item is optional. Check appropriate box in item 7 to request SearchReport(s) on all or some of the Debtors named in this Financing Statement.The Report will list all Financing Statements on file against the designatedDebtor on the date of the Report, including this Financing Statement.There is an additional fee for each Report. If you have checked a box initem 7, file Search Report Copy together with Filing Officer Copy (and Acknowledgment Copy). Note: Not all states do searches and not allstates will honor a search request made via this form; some states requirea separate request form.8.This item is optional and is for filer's use only. For filer's convenience of reference, filer may enter in item 8 any identifying information (e.g.,Secured Party's loan number, law firm file number, Debtor's name orother identification, state in which form is being filed, etc.) that filer mayfind useful.
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