HomeMy WebLinkAbout901403UCC 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)
I
UCC Direct Services
P.O. Box 29071
Glendale CA 91209-9071
I
File with: Lincoln, WY
9O
511466 ICOMMUNITY1
6324582
WYOM
F. IXTU RE
RECEIVED
LINCOLN COUNTY CLERK
[ 03
0It JUl 27 l i.'l 3:1]
v,
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1. DEBTOR'S EXACT FULL LEGAL NAME - insed only one_ debtor name (la or lb) - do not abbreviate or combine names
FIRST NAME
MIDDLE NAME
SUFFIX
la. ORGANIZATION'S NAME
OR lb. INDIVIDUAL'S LAST NAME
Gray Ronald
lc. MAILING ADDRESS CITY
1424 Central Ave. Kemmerer
ld. SEE INSTRUCTIONS If JURISDICTION OF ORGANIZATION
DD'L INFO RE le. TYPE OF ORGANIZATION
RGAN IZATION
EBTOR
STATE POSTAL CODE
WY 83101
lg. ORGANIZATIONAL ID # if any
COUNTRY
[~NONE
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insed only one_ debtor name (2a or 2b) - do not abbreviate or combine names
2a. ORGANIZATION'S NAME
3R
2b: INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
Gray Jean M.
2c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY
1424 Central Ave. Kemmerer WY 83101
2d. SEE NSTRUCT ONSI°RGANIZATI°NFDD'L INFO RE 2e. TYPE OF ORGANIZAT!ON 21. JURISDICTION OF ORGANIZATION 2g. ORGANIZATIONAL ID #, if any
iOEBTOR ' []NONI
m
m
3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - insed only one secured party name (3a or 3b)
OR 13b. INDIVIDUAL'S LAST NAME
3a. ORGANIZATION'S NAME
Community First National Bank
FIRST NAME MIDDLE NAME SUFFIX
CiTY STATE I POSTAL CODE
3c. MAILING ADDRESS COUNTRY
801 Pine Avenue Kemmerer WY 83101
4. :This FINANCING STATEMENT covers the following collateral:
FIXTURES: Ail ¢loods now or in lhe future affixed or altached to real estate. All fixtures or goods lo become fixtures located at: 1424 Central Ave,
Kemmerer WY 83101
m
m
mm
mm
m
m
m
5. ALTERNATIVEDESIGNATION[ffapplfcabIe] [~LESSEE/LESSOR [~CONSIGNEE/CONSIGNOR [~BAILEE/BAILOR ,~. SELLEPJBUYER ~-~AG. LIEN [~]NON-UCCFtLING
6. ~'1This FINANCING STATEMENT is to be filed [,er record] (or recorded)in the REALm '. SEARCH REPOR~(~)on Debtor(s) ~All .eblors ~Deblor 1 ~Deblo, 2
~'uESTATERECORDS, AtlachAddendum tmfaoolicablel I IADDITIONALFEEI loolion~lI
8. OPTIONAL FILER REFERENCE DATA
6324582 ¢3888603300/519-58-2415 0311
,;.,4[; ',,,' '~:~? Prepared by UC( :, :~s PO Box29071
:ILING OFFICE COPY',.[,t.;e,~, ;, :~ ,L UCC FINANCING STATEMENT (FORM UCC1)
. .......... Gle¢~dale. CA 91___ ¢ . ~ '. ~.J(800) 331-3282
FiNANCiNG STATEMENT ADDENDUM
:OLLOW INSTRUCTIONS lfront and back) CAREFULLY
}. NAME'OF FIRST DEBTOR (la or lb) ON RELATED FINANCING STATEMENT
ga. ORGANIZATION'S.. NAME
9b. INDIVIDUAL'S LAST NAME
Gray
FIRST NAME
Rona d
.DDLE NAME.SUFFIX
10. MISCELLANEOUS
~324582-40-1
511466 ICOMMUNI~Y1
~3888603300/519-58-2415
3311
File with: Lincoln, WY
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insed only one name (1 la or 1 lb) - do not abbreviate or combine names
1 la. ORGANIZATION'S NAME
1 lb, INDIVIDUAL'S £AST NAME FIRST NAME MIDDLE NAME SUFFIX
lc. MAILING ADDRESS CITY: STATE POSTAL CODE COUNTRY
[ld. SEE INSTRUCTION · ADD'L INFO RE 110. TYPE OF ORGANIZATION 1Ii]JURISDICTION OF ORGANIZATION 11g. ORGANIZATIONAL ID # if any
·ORGANIZATION
DEBTOR [] NON[
t2. [] ADDITIONAL SECURED PARTY'S o~r [] ASSIGNOR S/P's NAME'- insert only one name (12a or 12b)
I 12a. ORGANIZATION'S NAME
)R 12b. INDIVIDUAL'S LAST NAME FIRST NAME SUFFIX
12c. MAILING ADDRESS
13. This FINANCING STATEMENT covers [] t~mher to be cut or [] as-extracleo
collateral or is filed as a [] fixture filing
14. Description of real estale;
Description: The .qoods are or are to become fixtures on:
Lots 8, 9, 10 and 11 of Block 8 of Fairview Addition to the
Town of Kemmerer, Lincoln County, Wyoming as described
on the official plat thereof
15. Name ano address o[ a RECORD OWNER o1' above-described real estate
0f Debtor does not have a record interest):
CITY
16. Additional cofialeral descnpuon:
MIDDLE NAME
STATE IPOSTAL CODE
COUNTRY
1?. Check only ii applicable and check ~ one box,
Debtor is a[~ Trus, or [~ Trusiee ac,lng with respect ,o property held ,n ,rus[ or ~] Decedenl's Es,ate
18. Check only ii applicable and check only one Dox
D Debtor is a TRANSMITTING UTILITY
]]Filed in conneclion wlln a Manufaclured-Home Transaclion -- effeclive 30 ~'ears
E--]Filed in conneclioo wilh a Public-Finance Transaction -- e[feclive 30 years
Prepared by UCC Direcl Services mc P.O Box 29071
LING OFFICE COPY - NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV 05~22~02) Gler~dale. CA 91209~9071 're~ (Mo0) s:~ 1-32~2