Neb. U.C.C. §9-521 Uniform Form of Written Financing Statement and Amendment

• Library: Nebraska Revised Statutes
• Edition: 2021
• Currency: Current through the 2021 Special Legislative Session
• Year: 2021
• Citation: Neb. U.C.C. §9-521

(a) A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in section 9-516(b):

UCC FINANCING STATEMENT

FOLLOW INSTRUCTIONS

A. NAME & PHONE OF CONTACT AT FILER (optional)

_______________________

B. E-MAIL CONTACT AT FILER (optional)

_______________________

C. SEND ACKNOWLEDGMENT TO: (Name and Address)

_______________________

THE ABOVE SPACE IS FOR

FILING OFFICE USE ONLY

1. DEBTOR'S NAME - provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)

<TABLE border="1"> <TR><TD> <para>1a. ORGANIZATION'S NAME</para> <para>______________________</para></TD> </TR> <TR><TD> <para>OR</para></TD> </TR> <TR><TD> <para>1b. INDIVIDUAL'S SURNAME</para> <para>_______________________</para></TD><TD> <para>FIRST PERSONAL NAME</para> <para>_____________________</para></TD> </TR> </TABLE>

<TABLE border="1"> <TR><TD> <para>ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR</para> <para>____________________</para></TD><TD> <para>SUFFIX</para> <para>_________</para></TD> </TR> </TABLE>

<TABLE border="1"><TBODY> <TR><TD>1c. MAILING ADDRESS </TD> </TR> <TR><TD>________________________________________ </TD> </TR></TBODY> </TABLE>

<TABLE border="1"><TBODY> <TR><TD>CITY </TD><TD>STATE </TD><TD>POSTAL CODE </TD><TD>COUNTRY</TD> </TR> <TR><TD>__________ </TD><TD>__________ </TD><TD>__________ </TD><TD>__________</TD> </TR></TBODY> </TABLE>

2. DEBTOR'S NAME - provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)

<TABLE border="1"><TBODY> <TR><TD> <para>2a. ORGANIZATION'S NAME</para> <para> ________________________________</para></TD> </TR> <TR><TD> <para>OR</para></TD> </TR></TBODY> </TABLE>

<TABLE border="1"> <TR><TD> <para>2b. INDIVIDUAL'S SURNAME</para> <para>____________________</para></TD><TD> <para>FIRST PERSONAL NAME</para> <para>_________</para></TD> </TR> </TABLE>

<TABLE border="1"><TBODY> <TR><TD>ADDITIONAL NAME(S)/INITIAL(S) THAT ARE </TD> </TR> <TR><TD>PART OF THE NAME OF THIS DEBTOR </TD><TD>SUFFIX</TD> </TR> <TR><TD>________________________________ </TD><TD>_____________</TD> </TR></TBODY> </TABLE>

<TABLE border="1"><TBODY> <TR><TD>2c. MAILING ADDRESS</TD> </TR> <TR><TD>________________________________________ </TD> </TR></TBODY> </TABLE>

<TABLE border="1"><TBODY> <TR><TD>CITY </TD><TD>STATE </TD><TD>POSTAL CODE </TD><TD>COUNTRY</TD> </TR> <TR><TD>__________ </TD><TD>__________ </TD><TD>__________ </TD><TD>__________</TD> </TR></TBODY> </TABLE>

3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY) - provide only one Secured Party name (3a or 3b)

<TABLE border="1"><TBODY> <TR><TD> <para>3a. ORGANIZATION'S NAME</para> <para> ________________________________</para></TD> </TR> <TR><TD> <para>OR</para></TD> </TR></TBODY> </TABLE>

<TABLE border="1"> <TR><TD> <para>3b. INDIVIDUAL'S SURNAME</para> <para>____________________</para></TD><TD> <para>FIRST PERSONAL NAME</para> <para>_________</para></TD> </TR> </TABLE>

<TABLE border="1"><TBODY> <TR><TD>ADDITIONAL NAME(S)/INITIAL(S) </TD><TD>SUFFIX</TD> </TR> <TR><TD>________________________________ </TD><TD>_____________</TD> </TR></TBODY> </TABLE>

<TABLE border="1"><TBODY> <TR><TD>3c. MAILING ADDRESS</TD> </TR> <TR><TD>________________________________________ </TD> </TR></TBODY> </TABLE>