Free Information Request - Connecticut

STATE OF CONNECTICUT INFORMATION REQUEST
MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. Box 150470 Hartford, CT 06115-0470 860-509-6002
See reverse side for complete instructions

DELIVERY ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06105 860-509-6002

Requesting Party
Name Address City State Zip

Cust ID ________________

Space for office use only

1.
OR

DEBTOR'S EXACT FULL LEGAL NAME ­ insert only one debtor name (1a or 1b) 1a. ORGANIZATION'S NAME 1b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

2. INFORMATION OPTIONS 2a. REQUEST FOR INFORMATION ($25 Fee) ALL (includes lapsed filings) Select one of the following two options COPY REQUEST Select one of the following two options SPECIFIC COPIES ONLY CERTIFIED ($25 Fee) ALL CERTIFIED PLAIN UNLAPSED PLAIN ($20 Fee) UNLAPSED

2b.

2C.

FILING NUMBER

FILING NUMBER

FILING OFFICER COPY ­ CONNECTICUT INFORMATION REQUEST FORM (REV. 05/23/2007)

Instructions for Connecticut Information Request Form
Please type or print this form. Be sure it is completely legible. Read all instructions. Follow instructions completely. Do not insert anything in the open space in the upper portion of this form; It is reserved for filing office use. 1. 1a. 1b. Debtor name: Enter only one Debtor name in item 1, an organization's name (1a) or an individual's name (1b) Enter Debtor's exact full name. Do not abbreviate. Organization Debtor "Organization" means an entity having a legal identity separate from its owner. Individual Debtor "Individual" means a natural person. For both organization and individual Debtors; Do not use Debtor's trade name, DBA, AKA, FKA, Division name, etc. in place of or combined with Debtor's legal name. 2. 2a. 2b. 2c. Please note that it is permissible to select an option in 2a and also check an option in 2b. Check appropriate box in item 2a; check "ALL" if you are requesting a search of all active records, including lapsed filings, or check "UNLAPSED" if you are requesting a search of only active records that have not lapsed. Check appropriate box in item 2b to request copies of records appearing on the search response; check "ALL" if you are requesting copies of all records, including lapsed fillings, or check "UNLAPSED" if you are requesting copies of only active records that have not lapsed. Complete item 2c if you are ordering copies of specific records by record number.