§ 28:9–521. Uniform form of written financing statement and amendment.
(a) 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 § 28:9-516(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 2b, leave all of itme 2 blank, check here [ ] and provide the Individual Debtor information in item 19 of the Finance Statement Addendum Form (Form UCC1Ad)
“1a. ORGANIZATION’S NAME
“............................................................
“OR
“1b. INDIVIDUAL’S SURNAME FIRST PERSONAL NAME
“.............................................
“ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR SUFFIX
“
“1c. MAILING ADDRESS
“............................................................
“CITY STATE POSTAL CODE COUNTRY
“............. ............ ....................
“2. 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 1blank, check here [ ] and provide the Individual Debtor information in item 10 of the Finance Statement Addendum Form (Form UCC1Ad)
“2a. ORGANIZATION’S NAME
“
“OR
“2b. INDIVIDUAL’S SURNAME FIRST PERSONAL NAME
“.............................................
“ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR 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
“
“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 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 □ Bailer/Bailor □ Licensee/Licensor
“8. OPTIONAL FILER REFERENCE DATA
“
“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
INDIVIDUAL’S SURNAME
“..................................................
FIRST PERSONAL NAME
“..................................................
“ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE
NAME OF THIS DEBTOR 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
“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) 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 § 28:9-516(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
“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) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor’s name)
“ORGANIZATION’S NAME
“
“OR
“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) THAT ARE PART OF THE
NAME OF THIS DEBTOR 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
“INDIVIDUAL’S SURNAME FIRST PERSONAL NAME
................................................................................
“ADDITIONAL NAME(S)/INITIAL(S) SUFFIX
“...........................................................................
“10. OPTIONAL FILER REFERENCE DATA
“
“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 for 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:
(c) A form that a filing office may not refuse to accept under subsection (a) or (b) of this section must conform to the format prescribed for the form by the National Conference of Commissioners on Uniform State Laws.
