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I
Bank of the West
4321 20th Ave SW
Fargo, ND 58103
-,
RECEIVED 10/29/2008 at 4:03 PM
RECEIVING # 943277
BOOK: 708 PAGE: 59
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
û00059
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
DENT
FIRST NAME
SHELLY
MIDDLE NAME
D.
SUFFIX
1c, MAILING ADDRESS
PO BOX 1013
CITY
KEMMERER
STATE
WY
POSTAL CODE
83101
COUNTRY
USA
1d. SEE INSTRUCTIONS
1e, TYPE OF ORGANIZATION
Individual
11. JURISDICTION OF ORGANIZATION
19. ORGANIZATIONAL ID #, If any
NONE
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME -Insert only one debtor neme (2a or 2b) - do no! abbreviate or combine names
2e, ORGANIZATION'S NAME
OR 2b, INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
2c, MAILING ADDRESS
CITY
STATE POSTAL CODE
COUNTRY
2d, SEE INSTRUCTIONS
2e. TYPE OF ORGANIZATION
21. JURISDICTION OF ORGANIZATION
2g, ORGAN IZATlONALI D #, if eny
NON
3, SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR SIP) - insert only one secured party name (3a or 3b)
3a. ORGANIZATION'S NAME
BANK OF THE WEST
OR 3b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME
SUFFIX
3c, MAILING ADDRESS
142 E 200 South
CITY
Salt Lake City
STATE
UT
POSTAL CODE
84111
COUNTRY
USA
4. Thts FINANCING STATEMENT covers the following colleteral:
Modular Home by Genesis Homes of Colorado, Model #902. Approximately 1,698 square feet; 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).
5. ALTERNATIVE DESIGNATION [If applicable]:
6. s 's to e e
ESTATE RECORDS. Attach Addendum
8. OPTIONAL FILER REFERENCE DATA
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
9b, INDIVIDUAl'S LAST NAME
DENT
FIRST NAME
SHELLY
MIDDLE NAME, SUFFI
D.
10, MISCELLANEOUS:
ûOvOSO
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME -Insart only one name (11a or 11b) - do not abbravlate or comblna names
-
11a. ORGANIZATION'S NAME
OR 11b, INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
11 c, MAILING ADDRESS CITY STATE I POSTAL CODE COUNTRY
11d, SEE INSTRUCTIONS IADD'L INFORE 111a, TYPE OF ORGANIZATION 111, JURISDICTION OF ORGANIZATION 11g, ORGANIZATIONAL 10 #, if any
ORGANIZATION n.,n.,,:
DEBTOR I I I
12. ~DDITIONAl SECURED PARTY'S or I ASSIGNOR SIP'S NAME -Insart only ona nama (12a or 12b)
12a. ORGANIZATION'S NAME
OR 12b, INDIVIDUAl'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
12c, MAILING ADDRESS CITY STATE rOSTAl CODE COUNTRY
13, This FINANCING STATEMENT covers Ombarto ba cut or []as-axtracted 16. Additional collataral description:
collataral. or Is filed as a Dxture filing,
14. Dascrlption ofraal astate:
Lot 1 of Block 1 of Mower Subdivision, Lincoln County,
Wyoming as described on the official plat thereof.
15. Nama and address of a RECORD OWNER of abova-deSCrlbed real estata (If
Debtor does not have a record Interast):
17, Check 2!2!Y If applicable and check 2!2!Y one box,
Debtor Is a r1rrust or r1rrustee acting with respect to property held In trust or nDecedent's Estate
18. Check 2!2!Y if applicable and check 2!2!Y one box,
_ Debtor Is a TRANSMITTING UTILITY
_ lied In connection with a Manufactured·Home Transaction - effective 30 years
Filed in connection with a Public-Finance Transaction - effective 30 years
FILING OFFICE COpy - UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. OS/22/02)
Harland Financial Solutions
400 S.W, 6th Avenue, Portland, Oregon 97204