§ 12a-1-9-521

UNIFORM FORM OF WRITTEN FINANCING STATEMENT AND AMENDMENT (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 subsection (b) of Section 1-9-516 of this title:UCC FINANCING STATEMENTFOLLOW INSTRUCTIONSA.NAME AND 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 ONLY1.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)1a. ORGANIZATION'S NAME_______________________________________________________________OR1b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX_______________________________________________________1c.

ME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX_______________________________________________________1c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY_______________________________________________________________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)2a. ORGANIZATION'S NAME_______________________________________________________________OR2b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX_______________________________________________________2c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY_______________________________________________________________3.SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY) – provide only one Secured Party name (3a or 3b)3a. ORGANIZATION'S NAME______________________________________________________________OR3b.

PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY) – provide only one Secured Party name (3a or 3b)3a. ORGANIZATION'S NAME______________________________________________________________OR3b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX__________________________________________________________3c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY_______________________________________________________________4.COLLATERAL: This financing statement covers the following collateral:_______________________________________________________________5.Check only if applicable and check only one box:Collateral is:[ ] held in a Trust (see instructions)[ ] being administered by a Decedent'sPersonal Representative.6a. Check only if applicable and check only one box:[ ] Public-Finance Transaction[ ] Manufactured-Home Transaction[ ] A Debtor is a Transmitting Utility6b. Check only if applicable and check only one box:[ ] Agricultural Lien[ ] Non-UCC Filing7.ALTERNATIVE DESIGNATION (if applicable):[ ] Lessee/Lessor[ ] Consignee/Consignor[ ] Seller/Buyer[ ] Bailee/Bailor[ ] Licensee/Licensor8.OPTIONAL

only one box:[ ] Agricultural Lien[ ] Non-UCC Filing7.ALTERNATIVE DESIGNATION (if applicable):[ ] Lessee/Lessor[ ] Consignee/Consignor[ ] Seller/Buyer[ ] Bailee/Bailor[ ] Licensee/Licensor8.OPTIONAL FILER REFERENCE DATA_______________________________________________________________UCC FINANCING STATEMENT (Form UCCI)UCC FINANCING STATEMENT ADDENDUMFOLLOW INSTRUCTIONS9.NAME OF FIRST DEBTOR (same as item 1a or 1b on Financing Statement)9a. ORGANIZATION'S NAME_______________________________________________________________OR9b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_________________________ __________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX_______________________________________________________________________________________ THE ABOVE SPACE IS FOR________________________________________ FILING OFFICE USE ONLY10.ADDITIONAL DEBTOR'S NAME – provide only one Debtor name (10a or 10b) - (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)10a. ORGANIZATION'S NAME_______________________________________________________________OR10b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME___________________________ ___________________________ADDITIONAL

10a. ORGANIZATION'S NAME_______________________________________________________________OR10b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME___________________________ ___________________________ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX_______________________________________________________10c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY_______________________________________________________________11.[ ] ADDITIONAL SECURED PARTY'S NAME or [ ] ASSIGNOR SECURED PARTY'S NAME – provide only one name (11a or 11b)11a. ORGANIZATION'S NAME_______________________________________________________________OR11b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX______________________________________________________11c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY_______________________________________________________________12. ADDITIONAL SPACE FOR ITEM 4 (Collateral)______________________________________________________________13.This FINANCING STATEMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS (if applicable)14.This FINANCING STATEMENT:[ ]

________________________________________________________13.This FINANCING STATEMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS (if applicable)14.This FINANCING STATEMENT:[ ] covers timber to be cut [ ] covers as-extracted collateral [ ] is filed as a fixture filing15.Name and address of a RECORD OWNER of the real estate described in item 16 (if Debtor does not have record interest):_______________________________________________________________16. Description of real estate:_______________________________________________________________17.MISCELLANEOUS:______________________________________________________________(b) A filing office that accepts written records for filing may not refuse to accept a written financing statement amendment in the following form, except for a reason set forth in subsection (b) of Section 1-9-516 of this title:UCC FINANCING STATEMENT AMENDMENTFOLLOW INSTRUCTIONSA.NAME AND PHONE OF CONTACT AT FILER (optional)_______________________________________________________________B.E-MAIL CONTACT AT FILER (optional)_______________________________________________________________C.SEND ACKNOWLEDGMENT TO: (Name and

l)_______________________________________________________________B.E-MAIL CONTACT AT FILER (optional)_______________________________________________________________C.SEND ACKNOWLEDGMENT TO: (Name and Address)______________________________________________________________________________ THE ABOVE SPACE IS FOR_______________________________________ FILING OFFICE USE ONLY1a. INITIAL FINANCING STATEMENT FILE NUMBER_______________________________________________________________1b. [ ] This FINANCING STATEMENT AMENDMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS.Filer: attach Amendment Addendum (Form UCC3Ad) and provide Debtor's name in item 13.2.[ ] TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of Secured Party authorizing this Termination Statement.3.[ ] ASSIGNMENT (full or partial): Provide name of Assignee in item 7a or 7b, and address of Assignee in item 7c and name of Assignor in item 9. For partial assignment, complete items 7 and 9 and also indicate affected collateral in item 8.4.[ ] CONTINUATION: Effectiveness of the Financing Statement identified above with respect to

in item 9. For partial assignment, complete items 7 and 9 and also indicate affected collateral in item 8.4.[ ] CONTINUATION: Effectiveness of the Financing Statement identified above with respect to security interest(s) of Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law.5.[ ] PARTY INFORMATION CHANGE:Check one of these two boxes:This Change affects [ ] Debtor or [ ] Secured Party of record.ANDCheck one of these three boxes to:[ ] CHANGE name and/or address: Complete item 6a or 6b, and item 7a or 7b and item 7c.[ ] ADD name: Complete item 7a or 7b, and item 7c.[ ] DELETE name: Give record name to be deleted in item 6a or 6b.6.CURRENT RECORD INFORMATION: Complete for Party Information Change – provide only one name (6a or 6b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name).6a. ORGANIZATION'S NAME_______________________________________________________________OR6b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX_____________________________________________________7.CHANGED OR ADDED

'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX_____________________________________________________7.CHANGED OR ADDED INFORMATION: Complete for Assignment or Party Information Change – provide only one name (7a or 7b) (use exact full name; do not omit, modify, or abbreviate any word in the Debtor's name).7a. ORGANIZATION'S NAME_______________________________________________________________OR7b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX_______________________________________________________________7c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY_______________________________________________________________8.[ ]COLLATERAL CHANGE:_______________________________________________________________Also check one of these four boxes:[ ] ADD collateral[ ] DELETE collateral [ ] RESTATE covered collateral[ ] ASSIGN collateralIndicate collateral:_______________________________________________________________9.NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT -

al [ ] RESTATE covered collateral[ ] ASSIGN collateralIndicate collateral:_______________________________________________________________9.NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT - provide only one name (9a or 9b) (name of Assignor, if this is an Assignment).If this is an Amendment authorized by a DEBTOR, check here [ ] and provide name of authorizing Debtor.9a. ORGANIZATION'S NAME_______________________________________________________________OR9b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX________________________________________________10.OPTIONAL FILE REFERENCE DATA_______________________________________________________________UCC FINANCING STATEMENT AMENDMENT (FORM UCC3)UCC FINANCING STATEMENT AMENDMENT ADDENDUMFOLLOW INSTRUCTIONS11.INITIAL FINANCING STATEMENT FILE NUMBER (same as item 1a on Amendment form)._______________________________________________________________12.NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on Amendment form).12a. ORGANIZATION'S NAME_______________________________________________________________OR12b.

___________________________12.NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on Amendment form).12a. ORGANIZATION'S NAME_______________________________________________________________OR12b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX_____________________________________________________________________________________________ THE ABOVE SPACE IS FOR________________________________________ FILING OFFICE USE ONLY13.Name of DEBTOR on related financing statement (Name of a current Debtor of record required for indexing purposes only in some filing offices – see Instruction for item 13 – insert only one Debtor name (13a or 13b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name).13a. ORGANIZATION'S NAME._______________________________________________________________OR13b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX__________________________________________________14.ADDITIONAL SPACE FOR ITEM 8

E FIRST PERSONAL NAME_______________________________________________________________ADDITIONAL NAME(S)/INITIAL(S)SUFFIX__________________________________________________14.ADDITIONAL SPACE FOR ITEM 8 (Collateral)_____________________________________________________________15.This FINANCING STATEMENT AMENDMENT: [ ] covers timber to be cut [ ] covers as-extracted collateral [ ] is filed as a fixture filing.16.Name and address of a RECORD OWNER of real estate described in item 17 (if Debtor does not have a record interest):______________________________________________________________17.Description of real estate:______________________________________________________________18.MISCELLANEOUS:______________________________________________________________UCC FINANCING STATEMENT AMENDMENT ADDENDUM (Form UCC3Ad)(c) A form that a filing office may not refuse to accept under subsection (a) or (b) of this section must conform to the format prescribed for the form by the National Conference of Commissioners on Uniform State Laws.Added by Laws 2000, c. 371, § 99, eff. July 1, 2001. Amended by Laws 2015, c. 374, § 15, eff. Nov. 1, 2015.