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00&334
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
LOAN SERVICING 800-775-8015
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
r;;ïRST MUTUAL BANK
I
RECEIVED 4/24/2009 at 1 :52 PM
RECEIVING # 946734
BOOK: 721 PAGE: 334
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
PO BOX 1647
BELLEVUE, WA 98009-1647
L
~
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1. DEBTOR'S EXACT FULL LEGAL NAME -Insert only I!!lII debtor name (1a 0' 1b) - do not ebb,evlate or combine names
1a. ORGANIZATION'S NAME
OR 1b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
ROBERTS MARY
1c. MAILING ADDRESS CITY STATE POSTALCODE COUNTRY
313 RUBY KEMMERER WY 83101 US
1d. TAX ID #: SSN OR EIN I ADD'L INFO RE l1e. TYPE OF ORGANIZATION 11. JURISDICTION OF ORGANIZATION 1Q. ORGANIZATIONAL ID #.If eny
g;~¢~~ZATION I I I nNONE
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert aniy I!!lII debta, name (2a 0' 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 rOSTALCODE COUNTRY
2d. TAX ID #: SSN OR EIN I ;DD'L INFO RE 12e. TYPE OF ORGANIZATION 21. JURISDICTION OF ORGANIZATION 20. ORGANIZATIONAL ID #, If any
ORGANIZATION I I I nNONE
DEBTOR
3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR SIP) -Insert aniy I!!lII secured party neme (3e 0' 3b)
3a. ORGANIZATION'S NAME FIRST MUTUAL BANK ¿4- 'Îtlt,___ Lf
OR ( '2."> J-u., 'I
3b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
3c. MAILING ADDRESS CITY STATE POSTALCODE COUNTRY
PO BOX 1647 BELLEVUE WA 98009-1647 US
4. This FINANCING STATEMENT cove,slhe fallawino callalerel:
WINDOWS
PARCEL ID: 21161440200300
LEGAL: THE LOT NUMBERED NINE (9) OF THE BLOCK NUMBERED TWENTY- TWO (22) OF THE FIRST ADDITION
TO THE TOWN OF KEMMERER, COUNTY OF LINCOLN, STATE OF WYOMING
SITUATE IN THE COUNTY OF LINCOLN, STATE OF WYOMING
ADDRESS: 313 RUBY, KEMMERER, WY 83101
C1F~~(n r,pr:: ~:H ~NG
/ I \..v('
Lì^L6''''
,
ROBERTS M 52 122509 00
FILING OFFICE COPY - NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29/98)
006335
UCC FINANCING STATEMENT ADDENDUM
OR
9b. INDIVIDUAL'S LAST NAME
ROBERTS
MIDDLE NAME,SUFFIX
MARY
10. MISCELLANEOUS:
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11 ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME-Insert only QQAneme (11e or 11b) -do not abbrevlete 0' combine name.
11 e. ORGANIZATION'S NAME
OR 11b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
11 c. MAILING ADDRESS CITY STATE IPOSTALCODE COUNTRY
11n TAX In#' RRN OR FIN I fDD'L INFO RE 111e. TYPE OF ORGANIZATION 111. JURISDICTION OF ORGANIZATION 110. ORGANIZATIONAL 10 #. If anv
ORGANIZATION DNONE
DEBTOR I I I
12. IADDITIONAL SECURED PARTY'S Q( I I ASSIGNOR SIP'S NAME -Insart anlYQQA name (12a or 12b)
12a. ORGANIZATION'S NAME
OR 12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME
SUFFIX
12c. MAILING ADDRESS CITY STATE /POSTALCODE COUNTRY
13. This FINANCING STATEMENT cove's 0 timbe, 10 be cut or 0 as-exl,ected 16. Additional colleteral dascrlptlon:
collaleral, 0' Is filed as a ~ fixlure filing. LEGAL: THE LOT NUMBERED NINE (9) OF THE BLOCK
14. Desc"pllon of reel estate. NUMBERED TWENTY- TWO (22) OF THE FIRST ADDITION TO
WINDOWS THE TOWN OF KEMMERER, COUNTY OF LINCOLN, STATE
OF WYOMING
PARCEL 10: 21161440200300
SITUATE IN THE COUNTY OF LINCOLN, STATE
OF WYOMING
ADDRESS: 313 RUBY, KEMMERER, WY 83101
15. Name and add,ess of a RECORD OWNER of above-described ,eal e.lale
(if Debto, does nol have a record Inle,e.I):
17. Check I!!Ib! if appliceble and check I!!Ib! one box. or n Deceden!'s Ëstale
Deblor Is a 'FITrusl o,nTruslee acting with ,e.pec! to prope,ly held In trusl
~. Check I!!Ib! If applicable and chack I!!Ib! one box.
I- Deblor Is a TRANSMITfING UTILITY
~ Filed in connection with a ManufBctured~Home Transaction _ effective 30 years
Flied In connection with a Public-Finance Transaction _ effectiva 30 years
FILING OFFICE COPY- NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98)