(a) A filing office that accepts written records for filing may not refuse to accept a written initial financing statement in the following form, except for a reason set forth in § 28:9-516(b):
| UCC FINANCING STATEMENT | |
| FOLLOW INSTRUCTIONS (front and back) CAREFULLY | |
| A. NAME AND PHONE OF CONTACT AT FILER [optional] | |
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| B. SEND ACKNOWLEDGMENT TO: (Name and Address) | |
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| | | | 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 |
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| OR | |
| 1b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME | SUFFIX |
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| 1c. MAILING ADDRESS | CITY | STATE | POSTAL CODE | COUNTRY |
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| 1d. TAX ID. NO. SSN OR EIN | ADD'L INFO. RE ORGANIZATION DEBTOR | 1e. TYPE OF ORGANIZATION | 1f. JURISDICTION OF ORGANIZATION | 1g. ORGANIZATIONAL ID No., if any |
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| | | | | [ ] 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 |
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| OR | |
| 2b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME | SUFFIX |
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| 2c. MAILING ADDRESS | CITY | STATE | POSTAL CODE | COUNTRY |
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| 2d. TAX ID. NO. SSN OR EIN | ADD'L INFO. RE ORGANIZATION DEBTOR | 2e. TYPE OF ORGANIZATION | 2f. JURISDICTION OF ORGANIZATION | 2g. ORGANIZATIONAL ID No., if any |
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| | | | | [ ] 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 |
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| OR | |
| 3b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME | SUFFIX |
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| 3c. MAILING ADDRESS | CITY | STATE | POSTAL CODE | COUNTRY |
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| 4. This FINANCING STATEMENT covers the following collateral: |
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| 5. ALTERNATIVE DESIGNATION [if applicable]: [ ] LESSEE/LESSOR [ ] CONSIGNEE/CONSIGNOR [ ] BAILEE/BAILOR [ ] SELLER/BUYER [ ] AG. LIEN [ ] NON-UCC FILING |
| 6. [ ] This FINANCING STATEMENT is to be filed (for record) (or recorded) in the REAL | 7. Check to REQUEST SEARCH REPORT(S) on Debtor(s) |
| ESTATE RECORDS. Attach Addendum [if applicable] | [ADDITIONAL FEE] [optional] [ ] All Debtors [ ] Debtor 1 [ ] Debtor 2 |
| 8. OPTIONAL FILER REFERENCE DATA | |
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| FILING OFFICE COPY--NATIONAL UCC FILING STATEMENT (FORM UCC 1) (REV. 07/29/98) |
| [Back of form] |
| UCC FINANCING STATEMENT ADDENDUM | |
| FOLLOW INSTRUCTIONS instructions (front and back) CAREFULLY. | |
| 9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT | |
| 9b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME, SUFFIX | |
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| THE ABOVE SPACE IS FOR |
| FILING OFFICE USE ONLY |
| 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 |
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| OR | |
| 11b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME | SUFFIX |
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| 11c. MAILING ADDRESS | CITY | STATE | POSTAL CODE | COUNTRY |
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| 11d. TAX ID. NO. SSN OR EIN | ADD'L INFO. RE ORGANIZATION DEBTOR | 11e. TYPE OF ORGANIZATION | 11f. JURISDICTION OF ORGANIZATION | 11g. ORGANIZATIONAL ID No., if any |
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| | | | | [ ] NONE |
| 12. | [ ] ADDITIONAL SECURED PARTY'S or [ ] ASSIGNOR S/P'S NAME-insert only one name (12a or 12b). |
| 12a. ORGANIZATION'S NAME |
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| OR | |
| 12b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME | SUFFIX |
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| 12c. MAILING ADDRESS | CITY | STATE | POSTAL CODE | COUNTRY |
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| 13. This FINANCING STATEMENT covers [ ] timber to be cut or [ ] as-extracted collateral, or is filed as a [ ] fixture filing. | 16. Additional collateral description: |
| 14. Description of real estate: | |
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| 15. Name and address of a RECORD OWNER of the above-described real estate (if Debtor does not have record interest): | |
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| 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--NATIONAL UCC FILING STATEMENT (FORM UCC 1Ad) (REV. 07/29/98) |
(b) A filing office that accepts written records for filing may not refuse to accept a written financing statement amendment in the following form, except for a reason set forth in § 28:9-516(b):
| FOLLOW INSTRUCTIONS (front and back) CAREFULLY | |
| A. NAME AND PHONE OF CONTACT AT FILER [optional] | |
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| B. SEND ACKNOWLEDGMENT TO: (Name and Address) | |
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| THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY |
| 1a. INITIAL FINANCING STATEMENT FILE NO. | 1b. [ ] This FINANCING STATEMENT AMENDMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS. |
| 2. [ ] TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of the Secured Party authorizing this Termination Statement. |
| 3. [ ] CONTINUATION: Effectiveness of the Financing Statement identified above with respect to security interest(s) of the Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law. |
| 4. [ ] ASSIGNMENT (full or partial): Give name of assignee in item 7a or 7b and address of assignee in item 7c; and also give name of assignor in item 9. |
| 5. AMENDMENT (PARTY INFORMATION): This Amendment affects [ ] Debtor or [ ] Secured Party of record. Check only one of these two boxes. Also check one of the following three boxes and provide appropriate information in items 6 and/or 7. |
| [ ] CHANGE name and/or address: Give current record name in item 6a or 6b; also give new name (if name change) in item 7a or 7b and/or new address (if address change) in item 7c. | [ ] DELETE name: Give record name to be deleted in item 6a or 6b. | [ ] ADD name: Complete item 7a or 7b, and also item 7c; also complete items 7d-7g (if applicable). |
| 6. | CURRENT RECORD INFORMATION: |
| 6a. ORGANIZATION'S NAME |
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| OR | |
| 6b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME | SUFFIX |
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| 7. | CHANGED (NEW) OR ADDED INFORMATION: |
| 7a. ORGANIZATION'S NAME |
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| OR | |
| 7b. INDIVIDUAL'S LAST NAME | FIRST NAME | MIDDLE NAME | SUFFIX |
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| 7c. MAILING ADDRESS | CITY | STATE | POSTAL CODE | COUNTRY |
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| 7d. TAX ID. NO. SSN OR EIN | ADD'L INFO. RE ORGANIZATION DEBTOR | 2e. TYPE OF ORGANIZATION | 2f. JURISDICTION OF ORGANIZATION | 2g. ORGANIZATIONAL ID No., if any |
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| | | | | [ ] NONE |
| 8. AMENDMENT (COLLATERAL CHANGE): check only one box |
| Describe collateral [ ] deleted or [ ] added, or give entire [ ] restated collateral description, or describe collateral [ ] assigned. |
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| 9. | NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT (name of assignor, if this is an Assignment). If this is an Amendment authorized by a Debtor which adds collateral or adds the authorizing Debtor, or if this is a Termination authorized by a Debtor, check here [ ] and enter name of DEBTOR authorizing this Amendment. |
| 9a. ORGANIZATION'S NAME |
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