§7-9A-521. Uniform form of written financing statement and amendment.

(a) Initial financing statement form. A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in Section 7-9A-516(b):

UCC FINANCING STATEMENT

FOLLOW INSTRUCTIONS

A. NAME & PHONE OF CONTACT AT FILER (optional) ___________________________________

B. E-MAIL CONTACT AT FILER (optional) _________

C. SEND ACKNOWLEDGMENT TO: (Name and Address)

_________________________________________________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY

1. DEBTOR'S NAME: Provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor's name); if any part of the Individual Debtor's name will not fit in line 1b, leave all of item 1 blank, check here [ ] and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)

1a. ORGANIZATION'S NAME _________________________________________

OR

1b. INDIVIDUAL'S SURNAME _________________

FIRST PERSONAL NAME ______________

ADDITIONAL NAME(S)/INITIAL(S) _______________

SUFFIX _________

1c. MAILING ADDRESS ____________________

CITY __________

STATE _________

POSTAL CODE _________

COUNTRY _________

2. DEBTOR'S NAME: Provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor’s name); if any part of the Individual Debtor's name will not fit in line 2b, leave all of item 2 blank, check here [ ] and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)

2a. ORGANIZATION'S NAME _________

OR

2b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) ___________________

SUFFIX _________

2c. MAILING ADDRESS _____________________

CITY _________

STATE _________

POSTAL CODE _________

COUNTRY _________

3. SECURED PARTY’S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only one Secured Party name (3a or 3b)

3a. ORGANIZATION'S NAME _________

OR

3b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX _________

3c. MAILING ADDRESS _________

CITY _________

STATE _________

POSTAL CODE _________

COUNTRY _________

4. COLLATERAL: This financing statement covers the following collateral: __________________________

5. Check only if applicable and check only one box:

Collateral is

[ ] held in a Trust (see UCC1Ad, Item 17 and Instructions)

[ ] being administered by a Decedent's Personal Representative

6a. Check only if applicable and check only one box:

[ ] Public-Finance Transaction

[ ] Manufactured-Home Transaction

[ ] A Debtor is a Transmitting Utility

6b. Check only if applicable and check only one box:

[ ] Agricultural Lien

[ ] Non-UCC Filing

7. ALTERNATIVE DESIGNATION (if applicable):

[ ] Lessee/Lessor

[ ] Consignee/Consignor

[ ] Seller/Buyer

[ ] Bailee/Bailor

[ ] Licensee/Licensor

8. OPTIONAL FILER REFERENCE DATA: _________________________________

[UCC FINANCING STATEMENT (Form UCC1)]

UCC FINANCING STATEMENT ADDENDUM

FOLLOW INSTRUCTIONS

9. NAME OF FIRST DEBTOR: Same as item 1a or 1b on Financing Statement; if line 1b was left blank because Individual Debtor name did not fit, check here [ ]

9a. ORGANIZATION'S NAME _________

OR

9b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX _________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY

10. DEBTOR'S NAME: Provide (10a or 10b) only one additional Debtor name or Debtor name that did not fit in line 1b or 2b of the Financing Statement (Form UCC1) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor’s name) and enter the mailing address in line 10c

10a. ORGANIZATION'S NAME _________

OR

10b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX _________

10c. MAILING ADDRESS _________

CITY _________

STATE _________

POSTAL CODE _________

COUNTRY _________

11. [ ] ADDITIONAL SECURED PARTY'S NAME or

[ ] ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b)

11a. ORGANIZATION'S NAME _________

OR

11b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX _________

11c. MAILING ADDRESS _________

CITY _________

STATE _________

POSTAL CODE _________

COUNTRY _________

12. ADDITIONAL SPACE FOR ITEM 4 (Collateral) ________________________________

13. [ ] This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS (if applicable)

14. This FINANCING STATEMENT:

[ ] covers timber to be cut

[ ] covers as-extracted collateral

[ ] is filed as a fixture filing

15. Name and address of a RECORD OWNER of real estate described in item 16 (if Debtor does not have a record interest): _________

16. Description of real estate: _________

17. MISCELLANEOUS: _________

(b) Amendment form. A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in Section 7-9A-516(b):

UCC FINANCING STATEMENT AMENDMENT

FOLLOW INSTRUCTIONS

A. NAME & PHONE OF CONTACT AT FILER (optional) _________

B. E-MAIL CONTACT AT FILER (optional)

C. SEND ACKNOWLEDGMENT TO: (Name and Address) _______________________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY

1a. INITIAL FINANCING STATEMENT FILE NUMBER _________

1b. [ ] This FINANCING STATEMENT AMENDMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS

Filer: attach Amendment Addendum (Form UCC3Ad) and provide Debtor’s name in item 13.

2. [ ] TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to the security interest(s) of Secured Party authorizing this Termination Statement

3. [ ] ASSIGNMENT (full or partial): Provide name of Assignee in item 7a or 7b, and address of Assignee in item 7c and name of Assignor in item 9 For partial assignment, complete items 7 and 9 and also indicate affected collateral in item 8

4. [ ] CONTINUATION: Effectiveness of the Financing Statement identified above with respect to the security interest(s) of Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law

5. [ ] PARTY INFORMATION CHANGE:

Check one of these two boxes:

This Change affects

[ ] Debtor or

[ ] Secured Party of record.

AND

Check one of these three boxes to:

[ ] CHANGE name and/or address: Complete item 6a or 6b; and item 7a or 7b and item 7c

[ ] ADD name: Complete item 7a or 7b, and item 7c

[ ] DELETE name: Give record name to be deleted in item 6a or 6b

6. CURRENT RECORD INFORMATION: Complete for Party Information Change - provide only one name (6a or 6b)

6a. ORGANIZATION'S NAME _________

OR

6b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX _________

7. CHANGED OR ADDED INFORMATION: Complete for Assignment or Party Information Change - provide only one name (7a or 7b) (use exact full name; do not omit, modify, or abbreviate any part of the Debtor's name)

7a. ORGANIZATION'S NAME _________

OR

7b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX __________

7c. MAILING ADDRESS _________

CITY _________

STATE _________

POSTAL CODE _________

COUNTRY _________

8. [ ] COLLATERAL CHANGE:

Also check one of these four boxes:

[ ] ADD collateral

[ ] DELETE collateral

[ ] RESTATE covered collateral

[ ] ASSIGN collateral

Indicate collateral:

9. NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT: Provide only one name (9a or 9b) (name of Assignor, if this is an Assignment)

If this is an Amendment authorized by a DEBTOR, check here [ ] and provide name of authorizing Debtor

9a. ORGANIZATION'S NAME _________

OR

9b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX _________

10. OPTIONAL FILER REFERENCE DATA: _________

[UCC FINANCING STATEMENT AMENDMENT (Form UCC3)]

UCC FINANCING STATEMENT AMENDMENT ADDENDUM

FOLLOW INSTRUCTIONS

11. INITIAL FINANCING STATEMENT FILE NUMBER: Same as item 1a on Amendment form _________

12. NAME OF PARTY AUTHORIZING THIS AMENDMENT: Same as item 9 on Amendment form _________

12a. ORGANIZATION'S NAME _________

OR

12b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX _________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY

13. Name of DEBTOR on related financing statement (Name of a current Debtor of record required for indexing purposes only in some filing offices - see Instruction item 13): Provide only one Debtor name (13a or 13b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor's name); see Instructions if name does not fit

13a. ORGANIZATION'S NAME _________

OR

13b. INDIVIDUAL'S SURNAME _________

FIRST PERSONAL NAME _________

ADDITIONAL NAME(S)/INITIAL(S) _________

SUFFIX ______________

14. ADDITIONAL SPACE FOR ITEM 8 (Collateral): _________

15. This FINANCING STATEMENT AMENDMENT:

[ ] covers timber to be cut

[ ] covers as-extracted collateral

[ ] is filed as a fixture filing

16. Name and address of a RECORD OWNER of real estate described in item 17 (if Debtor does not have a record interest):_________

17. Description of real estate: _________

18. MISCELLANEOUS: _________

[UCC FINANCING STATEMENT AMENDMENT ADDENDUM (Form UCC3Ad)]

(Act 2001-481, p. 647, §1; Act 2014-374, §1.)