HomeMy WebLinkAbout910533UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS [front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
TAMMY SPANN 307-352-0448
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
~['~ock Springs National Bank Mortgage Department
333 Broadway
Bock Springs, WY 82902
00! 0
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (la or qb) - do not abbreviate or combine names
I la. ORGANIZATION'S NAME
OR BLAZE-ON CONSTRUCTION COMPANY, INC.
'lb. INDIVIDUAL'S LAST NAME ; FIRST NAME
lc. MAILING ADDRESS CITY
40 BLAZON ST. DIAMONDVILLE
'Id. TAX ID #: SSN OR EIN ADD'L INFO RE le. TYPE OF ORGANIZATION
ORGAN ZAT ON
DEBTOR I C0rp0rati0n .
lf. JURISDICTION OF ORGANIZATION
WY
MIDDLE NAME
STATE POSTAL CODE
WY 83116
ISUFFIX
COUNTRY
lg. ORGANIZATIONAL ID #, if any
[] NON/-
.2,. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only on.._.[e debtor name (2a or 2b) - do not abbreviate or combine names
. .,..: 2a. ORGANIZATION'S NAME .
· OR 12b' INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME
I
2c. MAILING ADDRESS
2d. TAX ID ,It: SSN OR EIN
ADD'L INFO RE J2e, TYPE OF ORGANIZATION
ORGANIZATION
DEBTOR '
CITY
2f. JURISDICTION OF ORGANIZATION
2g', ORGANIZATIONAL ID #, if any
3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - insert only on.._.~e secured party name (3a or 3b)
3a. ORGANIZATION'S NAME
OR Rock Springs National Bank Mortgage Department
3b. INDIVIDUAL'S LAST NAME
iSUFFIX
COUNTRY
[] NONF
3c, MAILING ADDRESS
I FIRST NAME MIDDLENAME IISUFFIX
CiTY STATE POSTAL CODE COUNTRY
Bock Springs WY 82902
333 Broadway
4. This FINANCING STATEMENT covers the following collateral:
RECEIVED 8~2/2005 at 4:28 PM
RECEIVING # 910533
BOOK: 593 PAGE: i 10
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, VVY
SEE ATTACHED ADDENDUM
5. ALTERNATIVE DESIGNATION [if applicable]: [] LESSEE/LESSOR [] CONSIGNEE/CONSIGNOR [] BAILEE/BAILOR [] SELLER/BUYER [] AG. LIEN [] NON-UCC FLUNG
6. [] This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL J 7. Check to REQUEST SEARCH REPORT(S on Debtor s ~
ESTATE RECORDS. Attach Addendum [if a[3plicable] [ADDITIONAL FEE] optiona L~ All Debtors [] Debtor 1 [] Debtor 2
~. OPTIONAL FILER REFERENCE DATA
LOAN NUMBER 50-7561-9
FILING OFFICE COPY- NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29i98) Bankers Systems, Inc., St. Cloud, MN Form UCC-1-LAZ 5/3012001
,..,...~+~,~,...
UCC FINAI~ICING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
9. NAME OF FIRST DEBTOR {la or lb) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME
OR BLAZE-ON CONSTRUCTION COMPANY, INC.
9b. INDIVIDUAL'S LAST NAME I FIRST NAME
10. MISCELLANEOUS:
MIDDLE
NAME,SUFFIX
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only once name (1 la or 1 lb) - do not abbreviate or combine names
OR 11 la. ORGANIZATION'S NAME
1
1 lb. INDIVIDUAL'S LAST NAME
FIRST NAME
1 lc. MAILING ADDRESS CITY
1 ld. TAX ID #: SSN OR EIN 1 lf. JURISDICTION OF ORGANIZATION
ADD'L INFO RE J 1 lo. TYPE OF ORGANIZATION
ORGANIZATION
DEBTOR I
12. [] ADDITIONAL SECURED PARTY'S ~r
52a, ORGANIZATION'S NAME
OR 112b, INDIVIDUAL'S LAST NAME
ASSIGNOR S/P'S NAME - insert only on.._~e name (12a or 12b)
12c. MAILING ADDRESS CITY
13. This FINANCING STATEMENT covers [] timber to be cut or [] as*extracted 16. Additional collateral description:
collateral, or is filed as a ~] fixture filing.
4. Description of real estate:
SEE ATTACHED SCHEDULE "C"
MIDDLE NAME I SUFFIX
STATE IPOSTAL CODE ICOUNTRY
I
1 lg. ORGANIZATIONAL ID ~', if any
] NONF
15. Name and address of s RECORD OWNER of above-descri;3ed real estate
(if Debtor does not have a record interest):
MICHAEL D. HOHOUT AND BEVERLY E. KOHOUT
421 EMERALD ST.
KEMMERER WY, 83101
FIRST NAME iMIDDLENAME .. ISUFFIX
STATE IPOSTAL CODE COUNTRY
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~onl if applicable and check on~yonl one box.
[] Debtor is a TRANSMITTING UTILITY
] Filed in connection with a Manufactured-Nome Transaction -- effective 30 years
] Filed in connection with a Public-Finance Transaction -- effective 30 years
FILING OFFICE COPY,,; + .:' ;~;~_ UCC FINANCING STATEMENT ADDENDUM FORM UCC~o7/29/98 :::;~:' ':'
A portion of Lot~ 1 and 2 of Block 4 to the Original Townsite of
Remmerer, Lincoln County, Wyoming being more particularly described as
gOllows;
Beginning at the southwestez-ly corner of said BlOck 4, thence N 26°34
W, along the westerly boundary o.f said Block 4, 70.00 feat;
thence N 63~26' Et 46.~7 feet;
thence $ 26°34, E, 70.00 feet to a poiriC orl the southerly boundary
of said Block 4;
thence S 63026, W, alons~ the southerly boundary of ma%d Block 4,
46.~7 ~eet to the point of beginning.