FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT [optional] B. RETURN TO: (Name and Address) FILING OFFICE ACCT #
This document is designed to be a fillable form. Please be sure all pertinent information is completed before printing and mailing the form. Selecting 'Reset' will clear the entire form. PRIVACY ADVISORY: Information such as social security number, date of birth, maiden name, or financial institution account number is NOT required to be included in business entity or Uniform Commercial Code documents filed with the Secretary of State's office. Any information provided on these documents is subject to public viewing.
1. DEBTOR NAME to be searched - insert only one debtor name (1a or 1b) - do not abbreviate or combine names
1a. ORGANIZATION'S NAME
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1b. INDIVIDUAL'S LAST NAME
2. INFORMATION OPTIONS relating to UCC filings and other notices on file in the filing office that include as a Debtor name the name identified in item 1: 2a. SEARCH RESPONSE 2b. COPY REQUEST 2c. SPECIFIED COPIES ONLY CERTIFIED (Optional) Select one of the following two options: Select one of the following two options:
ALL (Check this box to request a response that is complete, including filings that have lapsed.) ALL
Date Record Filed ( if required) Type of Record and Additional Identifying Information (if required)
3. ADDITIONAL SERVICES:
4. DELIVERY INSTRUCTIONS (request will be completed and mailed to the address shown in item B unless otherwise instructed here): 4a. 4b. Pick Up Other
Specify desired method here (if available from this office); provide delivery information (e.g., delivery service's name, addressee's account # with delivery service, addressee's phone #, etc.)
(REV. 12/08) FILING OFFICE COPY (1) NATIONAL INFORMATION REQUEST (FORM UCC11) (REV. 05/09/01)
Instructions for National Information Request (Form UCC11)
Please type or laser-print this form. Be sure it is completely legible. Read all Instructions. Follow Instructions completely. Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. Filing office cannot give legal advice. Do not insert anything in the open space in the upper portion of this form; it is reserved for filing office use. When properly completed, send form parts 1 and 2 (labeled Filing Office Copy (1) and (2)), with required fee, to filing office. Always detach Requestor Copy. Filing office may offer additional information options. Contact filing office or use form specially designed by filing office to obtain additional information options. A. To assist filing officers that might wish to communicate with requestor, requestor may provide information in item A. This item is optional. B. Enter name and address of requestor in item B. This item is NOT optional. 1. Debtor name: Enter only one Debtor name in item 1, an organization's name (1a) or an individuals name (1b). Enter Debtors exact full legal name. Dont abbreviate.
1a. Organization Debtor. Organization means an entity having a legal identity separate from its owner. A partnership is an organization; a sole proprietorship is not an organization, even if it does business under a trade name. If Debtor is a partnership, enter exact full legal name of partnership; you need not enter names of partners as additional Debtors. If Debtor is a registered organization (e.g., corporation, limited partnership, limited liability company), it is advisable to examine Debtors current filed charter documents to determine Debtor's correct name, organization type, and jurisdiction of organization. 1b. Individual Debtor. Individual means a natural person; this includes a sole proprietorship, whether or not operating under a trade name. Dont use prefixes (Mr., Mrs., Ms.). Use suffix box only for titles of lineage (Jr., Sr., III) and not for other suffixes or titles (e.g., M.D.). Use married womans personal name (Mary Smith, not Mrs. John Smith). Enter individual Debtors family name (surname) in Last Name box, first given name in First Name box, and all additional given names in Middle Name box. For both organization and individual Debtors: Dont use Debtors trade name, DBA, AKA, FKA, Division name, etc. in place of or combined with Debtors legal name; you may add such other names as additional Debtors if you wish (but this is neither required nor recommended). 2. Information options relating to UCC filings and other notices on file in the filing office that include as a Debtor name the name identified in item 1. Please note that it is permissible to select an option in 2a and also check an option in 2b. Check the "CERTIFIED (Optional)" box appropriately in items 2a, 2b, or 2c.
2a. Check appropriate box in item 2a; the box "ALL" if you are requesting a search of all active records, including lapsed filings, or the box "UNLAPSED" if you are requesting a search of only active records that have not lapsed. 2b. Check appropriate box in item 2b to request copies of records appearing on the search response; the box "ALL" if you are requesting copies of all active records, including lapsed filings, or the box "UNLAPSED" if you are requesting copies of only active records that have not lapsed. 2c. Complete item 2c if you are ordering copies of specific records by record number. 3. Some filing offices offer service options in addition to those offered in item 2. These may be shown on the face of this form or may otherwise be publicized by the particular filing office. Caution: if any of these additional service options introduces a search criterion (e.g., limiting search to named Debtor at an address in a specified city and state) that narrows the scope of the search, this may result in an incomplete search (that fails to list all filings against the named Debtor) and you may fail to learn information that might be of value to you. Delivery Instructions: Unless otherwise instructed, filing office will mail information to the name and address in item B. If information will be picked up from the filing office, check the Pick Up box . Contact filing office concerning availability of other delivery options. For other than mail or pick up, check the Other box and specify the other delivery method that you are requesting. If requesting delivery service, provide delivery service's name and requestor's account number to bill for delivery charge. Filing office will not deliver by delivery service unless prepaid waybill or account number for billing is provided.