Revised Code of Washington - RCW Title 62A Uniform Commercial Code - Section 62A.9A-521 Uniform form of written financing statement and amendment

§ 62A.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 RCW 62A.9A-516(b):

UCC FINANCING STATEMENT

FOLLOW INSTRUCTIONS (front and back) CAREFULLY

NAME & PHONE OF CONTACT AT FILER [optional]

SEND ACKNOWLEDGMENT TO: (Name and Address)

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (1a or 1b) - do not abbreviate or combine names

1a.

ORGANIZATION'S NAME

1b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

1c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

1d. TAX ID #:

SSN OR EIN

ADD'L INFO RE

ORGANIZATION

DEBTOR

1e. TYPE OF

ORGANIZATION

1f. JURISDICTION OF

ORGANIZATION

1g. ORGANIZATIONAL

ID #, If any

NONE

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

2b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

2c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

2d. TAX ID #:

SSN OR EIN

ADD'L INFO RE

ORGANIZATION

DEBTOR

2e. TYPE OF

ORGANIZATION

2f. JURISDICTION OF

ORGANIZATION

2g. ORGANIZATIONAL

ID #, If any

NONE

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

3b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

3c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

This FINANCING STATEMENT covers the following collateral:

ALTERNATIVE DESIGNATION [if applicable]:

LESSEE/LESSOR

CONSIGNEE/CONSIGNOR

BAILEE/BAILOR

SELLER/BUYER

AG. LIEN

NON-UCC FILING

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

Check to REQUEST SEARCH REPORT(S) on Debtor(s)

All Debtors

Debtor 1

Debtor 2

[Additional Fee] [optional]

OPTIONAL FILER REFERENCE DATA

NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29/98)

UCC FINANCING STATEMENT ADDENDUM

FOLLOW INSTRUCTIONS (front and back) CAREFULLY

NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT

9a.

ORGANIZATION'S NAME

9b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

10.

MISCELLANEOUS:

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

11b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

11c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

11d. TAX ID #:

SSN OR EIN

ADD'L INFO RE

ORGANIZATION

DEBTOR

11e. TYPE OF

ORGANIZATION

11f. JURISDICTION OF

ORGANIZATION

11g. ORGANIZATIONAL

ID #, If any

NONE

12.

ADDITIONAL SECURED PARTY'S or ASSIGNOR S/P'S NAME - insert only one name (12a or 12b)

12a.

ORGANIZATION'S NAME

12b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

12c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

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:

15.

Name and address of a RECORD OWNER of above-described real estate

(if Debtor does not have a record interest):

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

NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98)

(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 RCW62A.9A-516 (b):

UCC FINANCING STATEMENT AMENDMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A.	NAME & PHONE OF CONTACT AT FILER [optional]
B.	SEND ACKNOWLEDGMENT TO: (Name and Address)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1a.	INITIAL FINANCING STATEMENT FILE #						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 changed) 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
OR
	6b.	INDIVIDUAL'S LAST NAME				FIRST NAME		MIDDLE NAME		SUFFIX
7.	CHANGED (NEW) OR ADDED INFORMATION:
	7a.	ORGANIZATION'S NAME
OR
	7b.	INDIVIDUAL'S LAST NAME				FIRST NAME		MIDDLE NAME		SUFFIX
7c.	MAILING ADDRESS			CITY		STATE		POSTAL CODE		COUNTRY
7d. TAX ID #: SSN OR EIN			ADD'L INFO RE ORGANIZATION DEBTOR		7e. TYPE OF ORGANIZATION		7f. JURISDICTION OF ORGANIZATION		7g. ORGANIZATIONAL ID #, If any		NONE
8.	AMENDMENT (COLLATERAL CHANGE): check only one box.
Describe collateral deleted or added, or give entire restated collateral description, or describe collateral assigned.
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
OR
	9b.	INDIVIDUAL'S LAST NAME				FIRST NAME		MIDDLE NAME		SUFFIX
10.	OPTIONAL FILER REFERENCE DATA
NATIONAL UCC FINANCING STATEMENT AMENDMENT (FORM UCC3) (REV. 07/29/98)
UCC FINANCING STATEMENT AMENDMENT ADDENDUM
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
11.	INITIAL FINANCING STATEMENT FILE # (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 LAST NAME				FIRST NAME		MIDDLE NAME		SUFFIX
13.	Use this space for additional information
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
NATIONAL UCC FINANCING STATEMENT AMENDMENT ADDENDUM (FORM UCC3Ad) (REV. 07/29/98)

[2000 c 250 § 9A-521.]

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Last modified: April 7, 2009