Filing Fee: $18 Follow Instructions Carefully
A. NAME & PHONE OF PERSON FILING THIS STATEMENT (optional) B. SEND ACKNOWLEDGMENT TO: (Name and Address) [ ]
] ABOVE SPACE FOR FILING OFFICE USE ONLY
1. Identification of the RECORD to which this CORRECTION STATEMENT relates. 1a. TYPE OF RECORD 1b. FILE # OF INITIAL FINANCING STATEMENT
2a. RECORD is inaccurate. Provide the basis for the belief of the person identified in item 4 that the RECORD identified in item 1 is inaccurate and indicate the manner in which the person believes the RECORD should be amended to cure the inaccuracy.
2b. RECORD was wrongfully filed. Provide the basis for the belief of the person identified in item 4 that the RECORD identified in item 1 was wrongfully filed.
3. If this CORRECTION STATEMENT relates to a RECORD filed [or recorded] in a filing office described in Section 9-501(a)(1) and this CORRECTION STATEMENT is filed in such a filing office, provide the date [and time] on which the INITIAL FINANCING STATEMENT identified in item 1b above was filed [or recorded]. 3a. DATE 3b. TIME
4. NAME OF PERSON AUTHORIZING THE FILING OF THIS CORRECTION STATEMENT 4a. ORGANIZATION'S NAME OR 4b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
FILING OFFICE COPY - CORRECTION STATEMENT (FORM UCC5) (REV. 08/05/08)