Form Ucc-1 - Financing Statement 2000
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1State of Florida
UNIFORM COMMERCIAL CODE
FINANCING STATEMENT
FORM UCC-1 (REV.2000)
This Financing Statement is presented to a filing officer pursuant to the Uniform Commercial Code:
1. Debtor (Last Name First if an individual)
1a. Date of Birth or FEI#
1b. Mailing Address
1c. City, State
1d. Zip Code
2. Additional Debtor or Trade Name (Last Name First if an individual)
2a. Date of Birth or FEI#
2b. Mailing Address
2c. City, State
2d. Zip Code
3. Secured Party (Last Name First if an individual)
3a. Mailing Address
3b. City, State
3c. Zip Code
4. Assignee of Secured Party (Last Name First if an individual)
4a. Mailing Address
4b. City, State
4c. Zip Code
5. This Financing Statement covers the following types or items or property [include description of real property on which located and owner of record when required.
If more space is required, attach additional sheet(s)].
6. Check only if Applicable:
Products of collateral are also covered.
Proceeds of collateral are also covered.
Debtor is transmitting utility.
7. Check appropriate box:
All documentary stamps due and payable or to become due and payable pursuant to s. 201.22 F.S., have been paid.
(one box must be marked)
Florida Documentary Stamp Tax is not required.
8. In accordance with s. 679.402(2) F.S., this statement is filed without the Debtor’s signature
to perfect a security interest in collateral:
9. Number of additional sheets presented:
already subject to a security interest in another jurisdiction when it was brought into this
state or debtor’s location changed to this state.
This Space for Use of Filing Officer
which is proceeds of the original collateral described above in which a security interest was
perfected.
as to which the filing has lapsed. Date filed
and previous
UCC-1 file number
.
acquired after a change of name, identity, or corporate structure of the debtor.
10. Signature(s) of Debtor(s)
11. Signature(s) of Secured Party or if Assigned, by Assignee(s)
12. Return Copy to:
Name
Address
Address
City, State, Zip
STANDARD FORM - FORM UCC-1
Approved by Secretary of State, State of Florida
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