Free EFS-3 Statement of Termination, Continuation, Assignment, Amendment - Oregon

EFS-3

STATE OF OREGON Corporation Division ­ UCC 255 Capitol Street NE, Suite 151 Salem, OR 97310-1327 (503) 986-2200 Facsimile (503) 373-1166 FilingInOregon.com

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STATEMENT OF TERMINATION, CONTINUATION, ASSIGNMENT, AMENDMENT
PLEASE TYPE OR PRINT LEGIBLY. READ INSTRUCTIONS BEFORE FILLING OUT FORM.

A. THIS STATEMENT REFERS TO ORIGINAL FINANCING STATEMENT No.: Date Filed:

G. AMENDMENT INFORMATION
Use this area to list collateral, amendment description, and other information.

B. TYPE OF AMENDMENT (CHECK ALL BOXES THAT APPLY). LAPSE/TERMINATION (NO FEE). The Secured Party certifies that they no longer claim interest under the financing statement bearing the file number shown in SECTION A. CONTINUATION. Submitted within six months prior to expiration date. ASSIGNMENT. The Secured Party assigns to the Assignee whose name and address is shown in SECTION E and bearing the file number shown in SECTION A. AMENDMENT. Financing statement bearing file number shown in SECTION A is amended as described in SECTION G. Mark One: C. NAME(S) OF PERSON(S) SUBJECTING FARM If Individual, list last name first. PRODUCTS TO THE SECURITY INTEREST. 1. 2. 3. MAILING ADDRESS: 1. 2. 3. D. SECURED PARTY NAME(S) AND ADDRESS(ES) - Business - Business - Business - Individual - Individual - Individual

Contact Name: E. ASSIGNEE NAME AND ADDRESS (IF ANY)

Phone No.:

Contact Name:

Phone No.:

Debtor

Secure Party

The requirement that a document be signed, authorized or otherwise authenticated by the debtor is satisfied if the debtor has executed a security agreement against a security interest in the farm products to the secured party ORS Ch. 80.115 (7)
RETURN TO (Please type within the box):

FEES
Make check for $10.00 payable to "Corporation Division." No fee for Termination. NOTE: Filing fees may be paid with VISA or MasterCard. The card number and expiration date should be submitted on a separate sheet of paper for your protection.
DO NOT SUBMIT DUPLICATES OF THIS FILING OR ITS ATTACHMENTS

421 (Rev. 06/07)

INSTRUCTIONS
1. PLEASE TYPE THIS FORM USING BLACK RIBBON OR PRINT LEGIBLY. Must be legible (type size, clarity, etc.) to be accepted for filing. 2. IF THE SPACE PROVIDED FOR ANY ITEM(S) ON THE FORM IS INADEQUATE, submit additional information on 8 1/2" X 11" sheets. DO NOT STAPLE, TAPE, OR GLUE ANYTHING TO THIS FORM. 3. DEBTOR, SECURED PARTY, ASSIGNEE (if any), NAMES AND ADDRESS should be identical to the original filing unless previously amended. Information of a record cannot be changed without a proper amendment being filed. Please provide complete information in the name and address areas. We consider spouses, dba's, and aka's as different and distinct names. 4. ORIGINAL FINANCING STATEMENT NUMBER AND DATE must be shown. Please do not list the numbers or dates from EFS-3s. 5. The EFS system does not provide for the Release option. Material changes may be transacted through an EFS Amendment. If you choose to release only a portion of the collateral, please mark the Amendment box and describe the collateral in the space provided. If you wish to remove the filing from our active records, this can be done by filing a termination statement. 6. AN ACKNOWLEDGMENT of your filed document will be mailed to the party indicated in the "Return to" section.

7. FARM PRODUCTS: For EFS-3 filings that affect the farm products, please use the area provided. You must list any codes and information needed for the
EFS-3 transaction. Use the codes listed below for filing in this program. If your product is not listed, please contact the Secretary of State's office. Please state clearly the change you are making (amending, deleting, modifying, changing descriptions, etc.).
PRODUCT GRAINS Barley Corn for Grain Oats Rye Triticale Wheat HAY & FORAGE Alfalfa Ensilage Grass & Grain Straw Hay Sorghum GRASS & LEGUME SEEDS Alfalfa Seed Bentgrass Bluegrass Brome Clover Fescue Field Peas Orchardgrass Rape Seed Ryegrass Timothy Vetch Wheat Grass Other Grass Seed Other Legume Seed FIELD CROPS Herbs Hops Mint Oil Seed Potatoes Sugarbeet Vegetable & Flower Seeds Canola FRUITS Apples Apricots Cantaloupes Cherries Grapes CODE 0101 0102 0103 0104 0105 0106 0201 0202 0203 0204 0205 0301 0302 0303 0304 0305 0306 0307 0308 0309 0310 0311 0312 0313 0314 0315 0401 0402 0403 0404 0405 0406 0407 0408 0501 0502 0503 0504 0505 PRODUCT FRUITS continued Peaches Pears Plums Prunes Watermelons Kiwi NUTS Filberts Walnuts BERRIES Blackberries Blueberries Boysen & Youngberries Other Cane berries Cranberries Currants Elderberries Gooseberries Loganberries Marion berries Raspberries Strawberries VEGETABLES Artichokes Asparagus Beans Beets Broccoli Brussels; Sprouts Cabbage Carrots Cauliflower Celery Corn Cucumbers Eggplant Garlic Kohlrabi Lettuce Mushrooms Onions Peas Peppers Pumpkins CODE 0506 0507 0508 0509 0510 0511 0601 0602 0701 0702 0703 0704 0705 0706 0707 0708 0709 0710 0711 0712 0801 0802 0803 0804 0805 0806 0807 0808 0809 0810 0811 0812 0813 0814 0815 0816 0817 0818 0819 0820 0821 PRODUCT VEGETABLES continued Radishes Rhubarb Rutabagas Spinach Squash Tomatoes Turnips SPECIALTY PRODUCTS Bees Bees Wax Bulbs Greenhouse Stock Honey Logs Nursery Stock Standing Timber Trees (except standing timber) Turf Sod Worms LIVESTOCK Cattle & Calves Goats Hogs & Pigs Horses Llamas Milk Mink Mules Rabbits Sheep & Lambs Wool Buffaloes Alpaca Reindeer POULTRY Broilers Chickens Ducks Eggs Geese Turkeys Ostriches Emu Rhea CODE 0822 0823 0824 0825 0826 0827 0828 0901 0902 0903 0904 0905 0906 0907 0908 0909 0910 0911 1001 1002 1003 1004 1005 1006 1007 1008 1009 1010 1011 1012 1013 1014 1101 1102 1103 1104 1105 1106 1107 1108 1109 PRODUCT FISH & SHELLFISH Fish & Shellfish COUNTY Baker Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill CODE 1201 CODE 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

County Codes: Locate the county name in which your product is produced from the list provided.

421 (Rev. 06/07)