STATE OF CONNECTICUT
UCC FINANCING STATEMENT AMENDMENT ADDENDUM
FOLLOW INSTRUCTIONS CAREFULLY
11. INITIAL FINANCING STATEMENT FILE # (same as item 1a on Amendment form)
12.
CHANGED (NEW) OR ADDED INFORMATION: 12a. ORGANIZATION'S NAME
OR 12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
12c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
12d.
TAX ID# EIN
13.
ADD'L INFO RE 12e. TYPE OF ORGANIZATION ORGANIZATION DEBTOR CHANGED (NEW) OR ADDED INFORMATION: 13a. ORGANIZATION'S NAME
12f. JURISDICTION OF ORGANIZATION
12g. ORGANIZATIONAL ID #, OPTIONAL
OR 13b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
13c.
MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
13d.
TAX ID# EIN
ADD'L INFO RE ORGANIZATION DEBTOR
13e. TYPE OF ORGANIZATION
13f. JURISDICTION OF ORGANIZATION
13g. ORGANIZATIONAL ID #, OPTIONAL
14. USE THIS SPACE FOR ADDITIONAL INFORMATION
FILING OFFICE COPY CONNECTICUT UCC FINANCING STATEMENT AMENDMENT ADDENDUM (FORM UCC3Ad) (REV. 09/28/2001)
Instructions for Connecticut UCC Financing Statement Amendment Addendum (Form UCC3Ad)
11. Enter information exactly as given in item 1 on Amendment form.
12. & 13 Use this space to change or add information. 14. If space on Amendment form is insufficient or you must provide additional information, enter additional information in item 14.