UCC FINANCING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
9a. ORGANIZATION'S NAME
9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
9b. INDIVIDUAL'S LAST NAME
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one name (11a or 11b) - do not abbreviate or combine names
11a. ORGANIZATION'S NAME
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11b. INDIVIDUAL'S LAST NAME
11c. MAILING ADDRESS
11d. SEE INSTRUCTIONS
ADD'L INFO RE ORGANIZATION DEBTOR
11e. TYPE OF ORGANIZATION
11f. JURISDICTION OF ORGANIZATION
11g. ORGANIZATIONAL ID #, if any NONE
12a. ORGANIZATION'S NAME
ADDITIONAL SECURED PARTY'S or
ASSIGNOR S/P'S NAME - insert only one name (12a or 12b)
12b. INDIVIDUAL'S LAST NAME
12c. MAILING ADDRESS
13. This FINANCING STATEMENT covers
collateral, or is filed as a fixture filing.
timber to be cut or
16. Additional collateral description:
14. Description of real estate:
15. Name and address of a RECORD OWNER of above-described real estate
(if Debtor does not have a record interest):
17. Check only if applicable and check only one box.
Debtor is a Trust or Trustee acting with respect to property held in trust or Decedent's Estate
18. Check only if applicable and check only one box.
Debtor is a TRANSMITTING UTILITY Filed in connection with a Manufactured-Home Transaction effective 30 years Filed in connection with a Public-Finance Transaction effective 30 years
FILING OFFICE COPY UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05/22/02)
International Association of Commercial Administrators (IACA)
Instructions for UCC Financing Statement Addendum (Form UCC1Ad)
9. 10. 11. Insert name of first Debtor shown on Financing Statement to which this Addendum relates, exactly as shown in item 1 of Financing Statement. Miscellaneous: Under certain circumstances, additional information not provided on Financing Statement may be required. Also, some states have non-uniform requirements. Use this space to provide such additional information or to comply with such requirements; otherwise, leave blank. If this Addendum adds an additional Debtor, complete item 11 in accordance with Instruction 1 of Financing Statement. To include further additional Debtors, attach either an additional Addendum (Form UCC1Ad) or Additional Party (Form UCC1AP) and follow Instruction 1 of Financing Statement for determining and formatting additional names. If this Addendum adds an additional Secured Party, complete item 12 in accordance with Instruction 3 of Financing Statement. To include further additional Secured Parties, attach either an additional Addendum (Form UCC1Ad) or Additional Party (Form UCC1AP) and follow Instruction 1 of Financing Statement for determining and formatting additional names. In the case of a total assignment of the Secured Partys interest before the filing of this Financing Statement, if filer has given the name and address of the Total Assignee in item 3 of Financing Statement, filer may give the Assignor S/Ps name and address in item 12.
13-15. If collateral is timber to be cut or as-extracted collateral, or if this Financing Statement is filed as a fixture filing, check appropriate box in item 13; provide description of real estate in item 14; and, if Debtor is not a record owner of the described real estate, also provide, in item 15, the name and address of a record owner. Also provide collateral description in item 4 of Financing Statement. Also check box 6 on Financing Statement. Description of real estate must be sufficient under the applicable law of the jurisdiction where the real estate is located. 16. 17. 18. Use this space to provide continued description of collateral, if you cannot complete description in item 4 of Financing Statement. If Debtor is a trust or a trustee acting with respect to property held in trust or is a decedents estate, check the appropriate box. If Debtor is a transmitting utility or if the Financing Statement relates to a Manufactured-Home Transaction or a Public-Finance Transaction as defined in the applicable Commercial Code, check the appropriate box.