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UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS Ifront and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional)
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
I JONAH BANK OF WYOMING
777 WEST FIRST STREET
CASPER, WY 82601
I
RECEIVED 7/9/2008 at 3:56 PM
RECEIVING # 940417
BOOK: 699 PAGE: 573
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER. WY
000573
L
.J
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (1a or 1b) - do not abbreviate or combine names
1a. ORGANIZATION'S NAME
OR 1b. INDIVIDUAL'S lAST NAME FIRST NAME MIDDLE NAME SUFFIX
KALUS IV JOSEPH G
1c. MAILING ADDRESS CITY STATE rOSTAl CODE COUNTRY
1470 N 600 W CENTERVILLE UT 84014 USA
1d. SEE INSTRUCTIONS I ;DD'l INFO RE 11e. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION 19. ORGANIZATIONAL 10 #. if any
ORGANIZATION I d"d I ~ NONE
DEBTOR I n IVI ua I I
2. 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
OR 2b. INDIVIDUAL'S lAST NAME FIRST NAME MIDDLE NAME SUFFIX
2c. MAILING ADDRESS CITY STATE rOSTAl CODE COUNTRY
2d. SEE INSTRUCTIONS I ;DD'l INFO RE 12.. TYPE OF ORGANIZATION 2f. JURISDICTION OF ORGANIZATION 2g. ORGANIZATIONAL 10 #, if any
ORGANIZATION n NONE
DEBTOR I I I
3. SECURED PARTY'S NAME (or NAME ofTOTAl ASSIGNEE of ASSIGNOR SIP) . insert oniy one secured party name (3a or 3b)
3a. ORGANIZATION'S NAME
JONAH BANK OF WYOMING
OR 3b. iNDIVIDUAl'S lAST NAME FIRST NAME MIDDLE NAME SUFFIX
3c. MAILING ADDRESS CITY STATE rOSTAl CODE COUNTRY
777 WEST FIRST STREET CASPER WY 82601 USA
4. This FINANCING STATEMENT covers the following collateral:
All Fixtures; whether any of the foregoing is owned now or acquired later; all accessions, additions, replacements, and substitutions relating
to any of the foregoing; all records of any kind relating to any of the foregoing; all proceeds relating to any of the foregoing (including
insurance, general intangibles and accounts proceeds).
31
,1
Debtor 2
FILING OFFICE COPY - UCC FINANCING STATEMENT (FORM UCC1) (REV. OS/22/02)
Harland Financial Solutions
400 S.W. 6th Avenue, Portland, Oregon 97204
UCC FINANCING STATEMENT ADDENDUM
FOllOW INSTRUCTIONS (front and back) CAREFUllY
9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME
OR M;DLE NAME, SUFFI)
9b. INDIVIDUAL'S LAST NAME FIRST NAME
KALUS IV JOSEPH
10. MISCELLANEOUS:
(/00574
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
OR 11 b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
11c. MAILING ADDRESS CllY STATE rOSTAL CODE COUNTRY
11d. SEE INSTRUCTIONS (DD'L INFO RE 11e. lYPE OF ORGANIZATION 111. JURISDICTION OF ORGANIZATION 11g. ORGANIZATIONALlD#, ilany
ORGANIZATION n NONE
DEBTOR I I I
12. lADDITIONAl SECURED PARTY'S or I I ASSIGNOR SIP'S NAME - insert only one name (12a or 12b)
12a. ORGANIZATION'S NAME
OR 12b. INDIVIDUAL'S LAST NAME MIDDLE NAME SUFFIX
FIRST NAME
12c. MAILING ADDRESS CllY STATE POSTALCODE COUNTRY
13. This FINANCING STATEMENT COVers o timber to be cut or o as-extracted 16. Additional collateral description:
collateral, or is filed as a Qg fixture filing.
14. Description 01 real estate:
LOT 37, AFTON AIRPARK, AFTON, LINCOLN COUNTY,
WYOMING
15. Name and address 01 a RECORD OWNER of above-described real estate
(il Debtor does not have a record interest):
17. Check ~ if applicable and check ~ one box.
Debtor is a n Trust or n Trustee acting with respect to property held in trust or n Decedenfs Eslete
18. Check~ if applicable and check~ one box.
.. Debtor is a TRANSMITTING UTI lilY
i= Filed in connection with a Manufactured-Home Transaction - effective 30 years
Filed in connection with a Public-Finance Transaction - effective for 30 years
FILING OFFICE COpy - UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05/22/02)
Harland Financial Solutions
400 S.W. 6th Avenue, Portland, Oregon 97204