SOUTH DAKOTA FINANCING STATEMENT UCC 1 APPROVED STANDARD FORM
Secretary of State 500 E. Capitol Pierre, SD 57501-5070 605-773-4422
Fees
Fee $ __________________ Account #_______________
Clear Form
HELP
PLEASE TYPE THE INFORMATION ON THIS FORM ACCORDING TO ALL INSTRUCTIONS PRINTED ON THE BACK OF THE UCC 1 FORM NOTE: Type smaller than 8 point is not acceptable. This is an example of 8 point type. 1. SECURED PARTY NAME AND ADDRESS insert only one secured party name (1a or 1b)
1a. ORGANIZATION'S NAME
or
1b. INDIVIDUAL'S LAST NAME
FIRST NAME CITY
MIDDLE NAME STATE POSTAL CODE
SUFFIX COUNTRY
1c. MAILING ADDRESS
2. or
ADDITIONAL SECURED PARTY or
2a. ORGANIZATION'S NAME 2b. INDIVIDUAL'S LAST NAME
ASSIGNEE OF SECURED PARTY NAME AND ADDRESS insert only one name (2a or 2b)
FIRST NAME CITY MIDDLE NAME STATE POSTAL CODE SUFFIX COUNTRY
2c. MAILING ADDRESS
3. DEBTOR'S EXACT FULL LEGAL NAME insert only one debtor (3a or 3b) do not abbreviate or combine names.
3a. ORGANIZATION'S NAME
or
3b. INDIVIDUAL'S LAST NAME
FIRST NAME CITY
MIDDLE NAME STATE POSTAL CODE 3G. ORGANIZATIONAL ID#, if any
SUFFIX COUNTRY
3c. MAILING ADDRESS 3d. TAX ID # SSN OR EIN
ADD'S INFO RE ORGANIZATION DEBTOR
3e. TYPE OF ORGANIZATION
3f. JURSIDICTION OF ORGANIZATION
NONE
4. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME insert only one debtor name (4a or 4b) do not abbreviate or combine names.
4a. ORGANIZATION'S NAME
or
4b. INDIVIDUAL'S LAST NAME
FIRST NAME CITY
MIDDLE NAME STATE POSTAL CODE 4G. ORGANIZATIONAL ID#, if any
SUFFIX COUNTRY
4c. MAILING ADDRESS 4d. TAX ID # SSN OR EIN
ADD'S INFO RE ORGANIZATION DEBTOR
4e. TYPE OF ORGANIZATION
4f. JURSIDICTION OF ORGANIZATION
NONE
5. This Financing Statement covers the following types (or items) of property: If collateral is goods which are or are to become fixtures, the below goods are affixed or to be affixed to:
Check (X) if covered:
PROCEEDS of collateral are also covered.
PRODUCTS of collateral are also covered.
Use the following spaces only for Farm Products requiring EFFECTIVE FINANCING STATEMENT (EFS)
FARM CODE (s) and PRODUCT(s) YEAR QUANTITY COUNTY CODE LOCATION IN COUNTY OR FURTHER DESCRIPTION
Pay proceeds to Debtor and Secured Party unless otherwise checked: Check only if applicable and check only one box.
Secured Party only
Debtor only
Debtor is a Transmitting Utility Filed in connection with a Manufactured Home Transaction effective 30 years. Filed in conjunction with a Public-Finance Transaction
Signature(s) of Debtor(s)
Signature of Secured Party
Check to REQUEST SEARCH REPORT(S) on Debtor(s)
All Debtors
Debtor 1
Debtor 2
Number of Additional Sheets, if any:
UCC 1 FORM Revised 07/01/2009