§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]