Free STATE OF FLORIDA - Florida


File Size: 103.1 kB
Pages: 3
Date: March 20, 2002
File Format: PDF
State: Florida
Category: Workers Compensation
Author: Loree Evans
Word Count: 766 Words, 4,885 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.fldfs.com/wc/pdf/ucc-1.pdf

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Preview STATE OF FLORIDA
STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT FORM
A. NAME & DAYTIME PHONE NUMBER OF CONTACT PERSON B. SEND ACKNOWLEDGEMENT TO: Name Address Address City/State/Zip THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

1. DEBTOR'S EXACT FULL LEGAL NAME INSERT ONLY ONE DEBTOR NAME (1a OR 1b) Do Not Abbreviate or Combine Names
1a. ORGANIZATION'S NAME 1b. INDIVIDUAL'S LAST NAME 1c. MAILING ADDRESS 1d. TAX ID# REQUIRED ADD'L INFO RE: ORGANIZATION DEBTOR FIRST NAME CITY 1e. TYPE OF ORGANIZATION MIDDLE NAME STATE POSTAL CODE SUFFIX COUNTRY

1f. JURISDICTION OF ORGANIZATION

1g. ORGANIZATIONAL ID# NONE

2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME INSERT ONLY ONE DEBTOR NAME (2a OR 2b) Do Not Abbreviate or Combine Names
2a. ORGANIZATION'S NAME 2b. INDIVIDUAL'S LAST NAME 2c. MAILING ADDRESS 2d. TAX ID# REQUIRED ADD'L INFO RE: ORGANIZATION DEBTOR FIRST NAME CITY 2e. TYPE OF ORGANIZATION MIDDLE NAME STATE POSTAL CODE SUFFIX COUNTRY

2f. JURISDICTION OF ORGANIZATION

2g. ORGANIZATIONAL ID# NONE

3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) INSERT ONLY ONE SECURED PARTY NAME (3a OR 3b)
3a. ORGANIZATION'S NAME 3b. INDIVIDUAL'S LAST NAME 3c. MAILING ADDRESS FIRST NAME CITY MIDDLE NAME STATE POSTAL CODE SUFFIX COUNTRY

4. This FINANCING STATEMENT covers the following collateral:

5. ALTERNATE DESIGNATION (if applicable)

LESSEE/LESSOR AG. LIEN

CONSIGNEE/CONSIGNOR NON-UCC FILING

BAILEE/BAILOR SELLER/BUYER

6. Florida DOCUMENTARY STAMP TAX YOU ARE REQUIRED TO CHECK EXACTLY ONE BOX All documentary stamps due and payable or to become due and payable pursuant to s. 201.22 F.S., have been paid. Florida Documentary Stamp Tax is not required. 7. OPTIONAL FILER REFERENCE DATA
STANDARD FORM - FORM UCC-1 (REV.12/2001) Filing Office Copy Approved by the Secretary of State, State of Florida

STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT FORM ADDENDUM
8. NAME OF FIRST DEBTOR (1aOR 1b) ON RELATED FINANCING STATEMENT
8a. ORGANIZATION'S NAME

8b. INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

9. MISCELLANEOUS:

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

10. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - INSERT ONLY ONE DEBTOR NAME (10a OR 10b) Do Not Abbreviate or Combine Names
10a. ORGANIZATION'S NAME

10b. INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

10c. MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

REQUIRED ADD'L INFO 10e. TYPE OF ORGANIZATION 10f. JURISDICTION OF ORGANIZATION 10g. ORGANIZATIONAL ID# RE: ORGANIZATION DEBTOR NONE 11. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) INSERT ONLY ONE SECURED PARTY NAME (11a OR 11b) 11a. ORGANIZATION'S NAME

10d. TAX ID#

11b. INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

11c. MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

12. This FINANCING STATEMENT covers
as-extracted collateral, or is filed as a 13. Description of real estate:

timber to be cut or fixture filing.

15. Additional collateral description:

14. Name and address of a RECORD OWNER of above-described real estate (if Debtor does not have a record interest): 16. 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 17. 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 STANDARD FORM - FORM UCC-1 ADDENDUM (REV.12/2001) Filing Office Copy Approved by the Secretary of State, State of Florida

Instructions for State of Florida UCC Financing Statement Form (Form UCC-1)
o o o Please type or laser-print this form. Be sure it is completely legible. Read all instructions on form. Forms must be completed according to Florida state law. Fill in form very carefully. If you have questions, consult your attorney. Filing office cannot give legal advice. Processing fees are set by the Florida Legislature, are non-refundable, and are subject to change. To verify processing fees, contact FLORIDAUCC, Inc. at (850) 222-8526 or email [email protected] Make checks payable to FLORIDAUCC, Inc. or the Florida Department of State. Send ONE copy of each filing request, with the appropriate non-refundable processing fee to: 1st Class Mail Overnight Courier Service FLORIDAUCC, Inc. FLORIDAUCC, Inc. PO Box 5588 2670 Executive Center Circle West, Suite 100 Tallahassee, FL 32314 Tallahassee, FL 32301 The acknowledgement copy will be returned to the address indicated in block B. Do not insert anything in the open space in the upper right hand portion of this form; it is reserved for filing office use. If you need to use attachments, you are encouraged to use the State of Florida Uniform Commercial Code Financing Statement Form Addendum.

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