§490:9-521  Uniform form of written financing statement and amendment.  (a)  A filing office that accepts written records for filing may not refuse to accept a written initial financing statement in the following form, except for a reason set forth in section 490:9-516(b):

 

UCC FINANCING STATEMENT

FOLLOW INSTRUCTIONS

 

A.    NAME & PHONE OF CONTACT AT FILER (optional)

____________________________________________

B.    E-MAIL CONTACT AT FILER (optional)

____________________________________________

C.    SEND ACKNOWLEDGMENT TO:  (Name and Address)

____________________________________________

 

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY 

 

1.    DEBTOR'S NAME - provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)

1a.    ORGANIZATION'S NAME

___________________________________________________________________________________________

OR

1b.    INDIVIDUAL'S SURNAME          FIRST PERSONAL NAME

_________________________________      _________________________________________________

ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR       SUFFIX

_______________________________________________________________________                  ________

1c.    MAILING ADDRESS

___________________________________________________________________________________________

CITY                  STATE POSTAL CODE   COUNTRY

____________________________    ______  _____________   ___________

2.    DEBTOR'S NAME - provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)

2a.    ORGANIZATION'S NAME

_____________________________________________________________________

OR

2b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR       SUFFIX

_______________________________________________________________________                  ________

2c.    MAILING ADDRESS

___________________________________________________________________________________________

CITY                  STATE POSTAL CODE   COUNTRY

____________________________    ______  _____________   ___________

3.    SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY) - provide only one Secured Party name (3a or 3b)

3a.    ORGANIZATION'S NAME

_____________________________________________________________________

OR

3b.    INDIVIDUAL'S SURNAME          FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S)                                SUFFIX

_______________________________________________________________________                  ________

3c.    MAILING ADDRESS

___________________________________________________________________________________________

CITY                  STATE POSTAL CODE   COUNTRY

____________________________    ______  _____________   ___________

4.     COLLATERAL:  This financing statement covers the following collateral:

_____________________________________________________________________

5.    Check only if applicable and check only one box:

Collateral is       held in a Trust (see Instructions)

  being administered by a Decedent's Personal Representative.

6a.   Check only if applicable and check only one box:

  Public-Finance Transaction     Manufactured-Home Transaction

  A Debtor is a Transmitting Utility

6b.    Check only if applicable and check only one box:

  Agricultural Lien       Non-UCC Filing

7.    ALTERNATIVE DESIGNATION (if applicable):       Lessee/Lessor       Consignee/Consignor

              Seller/Buyer       Bailee/Bailor       Licensee/Licensor

8.    OPTIONAL FILER REFERENCE DATA

_____________________________________________________________________

[UCC FINANCING STATEMENT (Form UCC1)]

 

UCC FINANCING STATEMENT ADDENDUM

FOLLOW INSTRUCTIONS

9.    NAME OF FIRST DEBTOR (same as item 1a or 1b on Financing Statement)

9a.    ORGANIZATION'S NAME

_____________________________________________________________

OR

9b.    INDIVIDUAL'S SURNAME

_____________________________________________________________________

FIRST PERSONAL NAME

_____________________________________________________________________

ADDITIONAL NAME(S)/INITIAL(S)                                SUFFIX

_______________________________________________________________________                  ________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY 

 

10.    ADDITIONAL DEBTOR'S NAME - provide only one Debtor name (10a or 10b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)

10a.  ORGANIZATION'S NAME

_____________________________________________________________________

OR

10b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR       SUFFIX

_______________________________________________________________________                  ________

10c.    MAILING ADDRESS

___________________________________________________________________________________________

CITY                  STATE POSTAL CODE   COUNTRY

____________________________    ______  _____________   ___________

 

11.    ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME - provide only one name (11a or 11b)

11a.    ORGANIZATION'S NAME

_____________________________________________________________________

OR

11b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S)                                 SUFFIX

_______________________________________________________________________                  ________

11c.    MAILING ADDRESS

___________________________________________________________________________________________

CITY                  STATE POSTAL CODE   COUNTRY

____________________________    ______  _____________   ___________

12.    ADDITIONAL SPACE FOR ITEM 4 (Collateral)

_____________________________________________________________________

 

13.      This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS (if applicable)

 

14.    This FINANCING STATEMENT:

    covers timber to be cut         covers as-extracted collateral         is filed as a fixture filing

15.    Name and address of a RECORD OWNER of real estate described in item 16 (if Debtor does not have a record interest):

_____________________________________________________________________

16.    Description of real estate:

_____________________________________________________________________

17.    MISCELLANEOUS:

_____________________________________________________________________

[UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad)]

 

     (b)  A filing office that accepts written records for filing may not refuse to accept a written financing statement amendment in the following form, except for a reason set forth in section 490:9-516(b):

 

UCC FINANCING STATEMENT AMENDMENT

FOLLOW INSTRUCTIONS

A.    NAME & PHONE OF CONTACT AT FILER (optional)

____________________________________________

B.    E-MAIL CONTACT AT FILER (optional)

____________________________________________

C.    SEND ACKNOWLEDGMENT TO:  (Name and Address)

____________________________________________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY 

 

1a.    INITIAL FINANCING STATEMENT FILE NUMBER

_____________________________________________________________________

1b.      This FINANCING STATEMENT AMENDMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS.

Filer:  attach Amendment Addendum (Form UCC3Ad) and provide Debtor's name in item 13.

2.       TERMINATION:  Effectiveness of the Financing Statement identified above is terminated with respect to the security interest(s) of Secured Party authorizing this Termination Statement

3.        ASSIGNMENT (full or partial):  Provide name of Assignee in item 7a or 7b, and address of Assignee in item 7c and name of Assignor in item 9.  For partial assignment, complete items 7 and 9 and also indicate affected collateral in item 8

4.        CONTINUATION:  Effectiveness of the Financing Statement identified above with respect to the security interest(s) of Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law

5.       PARTY INFORMATION CHANGE:

Check one of these two boxes:

This Change affects   Debtor or   Secured Party of record.

AND

Check one of these three boxes to:

    CHANGE name and/or address:  Complete item 6a or 6b, and item 7a or 7b and item 7c.

   ADD name:  Complete item 7a or 7b, and item 7c.

    DELETE name:  Give record name to be deleted in item 6a or 6b.

6.    CURRENT RECORD INFORMATION:  Complete for Party Information Change - provide only one name (6a or 6b)  (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)

6a.    ORGANIZATION'S NAME

_______________________________________________________________________

OR

6b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S)                                 SUFFIX

_______________________________________________________________________                  ________

7.    CHANGED OR ADDED INFORMATION:  Complete for Assignment or Party Information Change - provide only one name (7a or 7b) (use exact full name; do not omit, modify, or abbreviate any word in the Debtor's name)

7a.    ORGANIZATION'S NAME

_____________________________________________________________________

OR

7b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR       SUFFIX

_______________________________________________________________________                  ________

7c.    MAILING ADDRESS

___________________________________________________________________________________________

CITY                  STATE POSTAL CODE   COUNTRY

____________________________    ______  _____________   ___________

8.        COLLATERAL CHANGE:

Also check one of these four boxes:

    ADD collateral         DELETE collateral         RESTATE covered collateral

    ASSIGN collateral

Indicate collateral:

9.    NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT - provide only one name (9a or 9b) (name of  Assignor, if this is an Assignment)

If this is an Amendment authorized by a DEBTOR, check here and provide name of authorizing Debtor

9a.    ORGANIZATION'S NAME

_____________________________________________________________________

OR

9b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S)                                 SUFFIX

_______________________________________________________________________                  ________

10.    OPTIONAL FILER REFERENCE DATA

_____________________________________________________________________

[UCC FINANCING STATEMENT AMENDMENT (Form UCC3)]

 

UCC FINANCING STATEMENT AMENDMENT ADDENDUM

FOLLOW INSTRUCTIONS

11.    INITIAL FINANCING STATEMENT FILE NUMBER (same as item 1a on Amendment form)

_____________________________________________________________________

12.    NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on Amendment form)

12a.    ORGANIZATION'S NAME

_____________________________________________________________________

OR

12b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S)                                SUFFIX

_______________________________________________________________________                  ________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY 

 

13.    Name of DEBTOR on related financing statement (Name of a current Debtor of record required for indexing purposes only in some  filing offices - see Instruction for item 13 - insert only one Debtor name (13a or 13b)  (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)

13a.    ORGANIZATION'S NAME

_____________________________________________________________________

OR

13b.    INDIVIDUAL'S SURNAME         FIRST PERSONAL NAME

_________________________________      _____________________________

ADDITIONAL NAME(S)/INITIAL(S)                                SUFFIX

_______________________________________________________________________                  ________

14.    ADDITIONAL SPACE FOR ITEM 8 (Collateral)

_____________________________________________________________________

15.    This FINANCING STATEMENT AMENDMENT:         covers timber to be cut

   covers as-extracted collateral            is filed as a fixture filing

16.    Name and address of a RECORD OWNER of real estate described in item 17 (if Debtor does not have a record interest):

_____________________________________________________________________

17.    Description of real estate

_____________________________________________________________________

18.    MISCELLANEOUS:

_____________________________________________________________________

[UCC FINANCING STATEMENT AMENDMENT ADDENDUM (Form UCC3Ad)]

 

     (c)  A form that a filing office may not refuse to accept under subsection (a) or (b) must conform to the format prescribed for the form by the National Conference of Commissioners on Uniform State Laws. [L 2000, c 241, pt of §1; am L 2012, c 33, §17]