Free Correction Statement - Connecticut

STATE OF CONNECTICUT CORRECTION STATEMENT
MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. Box 150470 Hartford, CT 06115-0470 860-509-6002 Follow Instructions Carefully Requesting Party
Name Address

COURIER ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6002

Cust ID ________________

Fee $25

(Space for office use only)

City State Zip
1. FILE NUMBER OF ORIGINAL FINANCING STATEMENT

2.

DEBTOR'S EXACT FULL LEGAL NAME ­ insert only one debtor name (2a or 2b)

2a. ORGANIZATION'S NAME

OR

2b. INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

2c. ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

2d. TYPE OF ORGANIZATION

2e. JURISDICTION OF ORGANIZATION

2f. ORGANIZATIONAL ID #

(Optional)

3.

PLEASE MARK THE APPROPRIATE BOX (check only one box)

3a.

RECORD IS INACCURATE

3b.

RECORD WAS WRONGFULLY FILED

3c. State the reason why the record is inaccurate or was filed wrongfully.

3d. Describe how the record should be amended:

4.

NAME OF PERSON SUBMITTING THIS CORRECTION STATEMENT FOR FILING

4a. ORGANIZATION'S NAME

OR

4b. INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

4c. MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

FILING OFFICER COPY ­ CONNECTICUT CORRECTION STATEMENT)

Revised 1/2009

Instructions for Connecticut Correction Statement
Please type or print this form. Be sure it is completely legible. Read all Instructions. Do not insert anything in the open space in the upper portion of this form; it is reserved for filing office use. 1. 2. 2a. 2b. 2c. 2d,e,f. 3. File number: Enter file number of initial financing statement to which the Record that is the object of this Correction Statement relates. Enter only one file number. Debtor's Name: Enter only one debtor's name in 2a or 2b. Organizational Debtor Individual Debtor Enter Debtor's address Enter type & jurisdiction of organization for organizational debtor. If this Correction Statement is filed based on the filer's belief that the Record identified in item 1 is inaccurate, check box 3a, provide the basis for that belief in 3c; and indicate the manner in which the Record should be amended to cure the inaccuracy in 3d. If this Correction Statement is filed based on the filer's belief that the record identified in item 1 was wrongfully filed, check box 3b and provide the basis for belief in 3c and 3d. 4. Always enter name of the person who authorized the filing of this Correction Statement. This name must be the same as the name under which the record is indexed.

Revised 1/2009