HomeMy WebLinkAbout891429UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
Phone:(800) 331-3282 Fax: (818) 662-4141
B. SEND ACKNOWLEDGEMENT TO: (Name and Address) 51 1466 ICOMMUNITY1
I
UCC Direct Services
P.O. Box 29071
Glendale, CA 91209-9071
File 'with: Lincoln, WY
5851005
WYOM
RECEIVED
LINOOI._N COUNTY CLER
:" ...... 376
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
SUFFIX
1. DEBTOR'S EXACT FULL LEGAL NAME - insed only on._.Ee debtor name (la or lb) - do not abbreviate or combine names
la. ORGANIZATION'S NAME
OR lb. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME
IKellen William
lc. MAILING ADDRESS CITY
PO Box 606 Pinedale
ld. TAX ID #: SSN OR Elk lf. JURISDICTION OF ORGANIZATION
DD'LINFO RE Ie. TYPE OF ORGANIZATION
RGANIZATION
EBTOR
G
STATE I POSTAL CODE
WY 82941
COUNTRY
lg. ORGANIZATIONAL ID #. if any
--INONE
SUFFIX
2, ,~,D~IT!ONAI:, DEBTOR'S EXACT FULL LEGAL NAME - nsed on y on.._~e 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
Kellen Sherw
2c. MAILING ADDRESS CITY
PO Box 606 Pinedale
2f. JURISDICTION OF ORGANIZATION
2d. TAX ID #: SSN OR ElkbDD'L INFO RE 2e. TYPE OF ORGANIZATION
IORGANIZATION
IDEBTOR
P
STATE POSTAL CODE
WY 82941
COUNTRY
2g. ORGANIZATIONAL ID #, il any
UNONE
3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - insert only once secured party name (3a or 3b)
3a. ORGANIZATION'S NAME
OR Community First National Bank
INDIVIDUAL'S LAST NAME
m
FIRST NAME MIDDLE NAME SUFFIX
__ 3c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY
PO Box 6080 Fargo ND 58108
4. This FINANCING STATEMENT covers the follOWing collateral:
FIXTURES ALL GOODS NOW OR IN THE FUTURE AFFIXED OR ATTACHED TO REAL ESTATE. ALL FIXTURES OR GOODS TO BECOME
FIXTURES LOCATED AT 700 JC PENNEY DRIVE, KEMMERER, WY 83101.
5. ALTERNATIVE DESIGNATION[il applicable] E~JLESSEE/LESSOR F~CONSIGNEE/CONSIGNOR ~]BAILEE/BAILOR F~SELLEPJBUYER I-]AG.LIEN [~NON-UCCFILING
6. ~ This FINANCING STATEMENT is to be filed [for record] (or recorded)in Ihe REAL J 7. Check ,o REQUEST SEARCH REPORT(S)on Debtor(s) [~AJJ Debtors r-'-IDebtor 1
Debtor 2
"- -JESTATE RECORDS. Attach Addendum Iifaoolicable]J [ADDITIONAL FEE1 lgDligP~lJ I I LJ .
8. OPTIONAL FILER REFERENCE DATA ~!"
585i 005 3888601230 0311
Prepared by UCC Direcl SlUices. PO. Box 29071,
FILING OFFICE COPY - NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29/g8) Glendale, CA g1209-907! Tel (800) 331-3282
3' 7
FINANCING 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 9b. INDIVIDUAL'S LAST NAME FIRST NAME ~DDLE NAME.SUFFIX
W am
Kellen
10. MISCELLANEOUS
5851005-40-1
511466 ICOMMUNITY1
3888601230
0311
File with: Lincoln, WY
THE ABOVE SPACE IS FOR FIL{NG OFFICE USE ONLY
1 1. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only once name (1 la or 1 lb) - do not abbreviate or combine names
1 la. ORGANIZATION'S NAME
JR
1 lb. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
1 lc. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY
1 ld. TAX ID#:.iSSN OR EIN - ADD'L INFO RE 11 e. TYPE OF ORGANIZATIQN 1 lf. JURISDICTION OF ORGANIZATION 1 lg. ORGANIZATIONAL ID #, if any
ORGANIZATION
, DEBTOR [ I NONI
12. E~ ADDITIONAL SECURED PARTY'S or [] ASSIGNOR SIP's NAME - insert only one name (12a or12b)
FIRST NAME
MIDDLE NAME
SUFFIX
f12a. ORGANIZATION'; NAME
OR 12b. INDIVIDUAL'S ST NAME
12c. MAILING ADDRESS CITY
16. Additional collateral descxiption:
13. This FINANCING STATEMENT covers [] timber to be cut or [] as-extracted
collateral or is filed as a [] fixture filing.
14. Description of real estate:
Description: Lots 20 and 21 of Block 13 of the Ori.qinal
Town of Kemmerer, Lincoln County, Wyoming as described
on the official plat thereof.
15. Name and address of a RECORD OWNER of above-described real estate
(if Debtor does-not have a record interest):
STATE POSTAL CODE
COUNTRY
FILING OFFICE COPY - NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98)
Prepared by UCC-Direct Services, Inc., P.O Box 29071
Glendale, CA 91209-9071 Tel (800)331-3282
18. Check only if applicab!e and check only one box.
[---~ Debtor is a TRANSMITTING UTILITY
'~ Filed i0 connection with a Manufactured-Home Transaction - effective 30 years
[]Filed in connection with a Public-Finance Transaction - elfeclive 30 years
17. Check only if applicable and check ~ one box.
Debtor is a~] Trust or ["--] Trustee acting with respect to property held in trust or [] Oecedent's Estale