Form Ucc-1 - Uniform Commercial Code Financing Statement
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1PARTIES
FINANCING STATEMENT
Debtor name (last name first if individual) and mailing address:
Uniform Commercial Code Form UCC-1
IMPORTANT - Please read instructions before completing
Filing No. (stamped by filing officer): Date, Time, Filing Office (stamped by filing officer)
Print this form
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Debtor name (last name first if individual) and mailing address:
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The Financing Statement is presented for filing pursuant to the Uniform Commercial
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Code and is to be filed with the (check applicable box).
o
Debtor name (last name first if individual) and mailing address:
Secretary of the Commonwealth.
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Prothonotary of ___________________________________________County.
o
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real estate Records of ______________________________________County.
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Number of Additional Sheets (if any)
8
Optional Special Identification (Max. 10 characters):
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COLLATERAL
Secured Party(ies) name(s) (last name first if individual) and
Identify collateral by item and/or type:
address for security interest information:
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Assignee(s) of Secured Party name(s) (last name first if
individual) and address for security interest information:
o
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(check only if desired) Products of the collateral are also covered.
Identify related real estate if applicable. The collateral is, or includes (check
appropriate box(es) -
o
a.
crops growing or to be grown on -
o
b.
goods which are or are to become fixture on -
o
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c.
minerals or the like (including oil and gas) as extracted on -
o
Special Types of Parties (Check if applicable):
d.
accounts resulting from the sale of minerals or the like (including oil and gas) at
o
The terms “Debtor” and “Secured Party” mean “Lessee”
the wellhead or minehead on -
and “Lessor”, respectively.
the following real estate:
o
The terms “Debtor” and “Secured Party” mean
Street Address:
o
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“Consignee” and “Consignor”, respectively.
Describe at: Book__________of (check one)
Deeds
Mortgages, at Page(s)_______
o
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Debtor is a Transmitting Utility.
for___________________________County. Uniform Parcel Identifier___________________.
o
Described on Additional Sheet.
SECURED PARTY SIGNATURE(S)
Name of record owner (required only if no Debtor has an interest of record):
This statement is filed with only the Secured Party’s signature
to perfect a security interest in collateral (check applicable
box(es))-
o
10
a.
acquired after a change of name, identity or corporate
______
structure of the Debtor.
_____
DEBTOR SIGNATURE(S)
o
b.
as to which the filing has lapsed.
Debtor Signature(s):
c. already subject to a security interest in another county in
Pennsylvania -
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o
when the collateral was moved to this county.
o
when the Debtor’s residence or place of business was
moved to this county.
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d. already subject to a security interest in another jurisdiction -
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when the collateral was moved to Pennsylvania.
o
when the Debtor’s location was moved to Pennsylvania.
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o
e.
which is proceeds of the collateral described in block 9,
in which a security interest was previously perfected
describe proceeds in block 9, if purchased with cash
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proceeds and not adequately described on the
adequately described on the original financing statement.
RETURN RECEIPT TO:
Secured Party Signature(s):
(Required only if box(es) is checked above):
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Approved by the Secretary of the Commonwealth of Pennsylvania
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