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HomeMy WebLinkAbout940417 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