Financing Statement (Connecticut)
This is a financing statement in Connecticut. The form provided here is simply a sample of what the actual Form UCC 1 looks like.
FORM UCC-1/UNIFORM COMMERCIAL CODE/FINANCING STATEMENT
STATE OF CONNECTICUT/REV. 10/97
PLEASE TYPE OR PRINT
SPACE FOR OFFICE USE ONLY SPACE FOR OFFICE USE ONLY
WORK ORDER NUMBER FILING NUMBER
1. SPECIAL DEBTOR/COLLATERAL INFORMATION - CHECK AND COMPLETE IF APPLICABLE
____ a. Debtor is a transmitting utility as defined in section 42a-9-402 of the Connecticut General Statutes.
____ b. Debtor does not have an interest of record. The name of the owner of such interest is
_____________________
____ c. Products of collateral are claimed and thus covered.
____ d. (The Collateral is crops) The below described crops are growing or are to be grown on: (describe the real estate below or on a separate sheet).
____ e. (The below goods are to become fixtures) Describe the real estate below or on a separate sheet and file a financing statement on real estate records.
____ f. Party named in secured party block is a LESSOR and party named in debtor block is LESSEE.
____ g. Party named in secured party block is a CONSIGNOR and party named in debtor block is CONSIGNEE.
2. DEBTOR'S EXACT LEGAL NAME - Attach 8 l/2" x I I" sheet to present additional debtor information. ____ Check here for additional debtors.
IF INDIVIDUAL
LAST NAME ____________________________
FIRST NAME ____________________________
MIDDLE NAME ____________________________
SUFFIX ____________________________
S.S. NUMBER ____________________________
IF BUSINESS
NAME ____________________________
TAXPAYER I.D. # ____________________________
MAILING ADDRESS (Street or P.O. Box)
____________________________
CITY ____________________________
STATE ____________________________
COUNTRY ____________________________
POSTAL CODE ____________________________
3. SECURED PARTY'S FULL LEGAL NAME Attach 8 1/2" x II" sheet to present additional secured party information in conformity with the statement below.
IF INDIVIDUAL
LAST NAME ____________________________
FIRST NAME ____________________________
MIDDLE NAME ____________________________
SUFFIX ____________________________
S.S. NUMBER ____________________________
IF BUSINESS
NAME ____________________________
MAILING ADDRESS (Street or P.O. Box)
____________________________
CITY ____________________________
STATE ____________________________
TAXPAYER I.D. # ____________________________
COUNTRY ____________________________
POSTAL CODE ____________________________
4. (IF APPLICABLE) ASSIGNEE'S FULL LEGAL NAME
IF INDIVIDUAL:
LAST NAME ____________________________
FIRST NAME ____________________________
MIDDLE NAME ____________________________
SUFFIX ____________________________
S.S. NUMBER ____________________________
I F BUSINESS
NAME ____________________________
TAXPAYER I.D. # ____________________________
MAILING ADDRESS (Street or P.O. Box)
____________________________
CITY ____________________________
STATE ____________________________
COUNTRY ____________________________
POSTAL CODE ____________________________
5. THIS FINANCING STATEMENT COVERS THE FOLLOWING TYPES (or items) OF PROPERTY (Describe).
____________________________
NUMBER OF ADDITIONAL SHEETS PRESENTED
____________________________
SIGNATURE OF DEBTOR (or Assignor)
____________________________
SIGNATURE OF SECURED PARTY (or Assignee)
____________________________
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INSTRUCTIONS FOR FILLING OUT THIS FORM
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Please read and comply with the following itemized instructions.
1. SPECIAL DEBTOR/COLLATERAL INFORMATION: Read each statement carefully and place a check mark next to any applicable statements.
2. DEBTOR INFORMATION: Please provide full legal name(s) and distinguish between debtors who are individuals and debtors which are businesses by completing the appropriate blocks. Records in the Office of the Secretary of the State will reflect the distinction of debtor type made by the filer. Note that the address blocks apply to both individuals and businesses.
3. SECURED PARTY INFORMATION: Please provide full legal name(s) and distinguish between secured parties who are individuals and secured parties which are businesses by completing the appropriate blocks. Records in the Office of the Secretary of the State will reflect the distinction of secured party type made by the filer. Note that the address blocks apply to both individuals and businesses.
4. ASSIGNEE INFORMATION: Complete only to reflect an assignment in the original financing statement. Please provide full legal name(s) and distinguish between assignees who are individuals and assignees which are businesses by completing the appropriate blocks. Records in the Office of the Secretary of the State will reflect the distinction of assignee type made by the filer. Note that the address blocks apply to both individuals and businesses.
5. STATEMENT OF COLLATERAL: Please provide a description of the property used as collateral for the debt. A statement of the total number of attached sheets must be made under this heading.
GENERAL INFORMATION
Please note the following:
a. Pertinent signatures should be provided at the bottom of the form.
b. If additional space is needed please attach an 8 l//2 x 11 piece of paper and make the appropriate reference on the form.
c. The UCC-1 form has two parts, an original and a copy. The original is will be filed and the copy returned to the filer. Please do not detach the copy.