UNIFORM COMMERCIAL CODE
1. Name of Debtor: _______________________________
Address of Debtor: _______________________________
2. Name of Secured Party: _______________________________
Address of Secured Party: _______________________________
3. This Financing Statement covers the following types (or items) of property:
4. (Check here ___ if collateral is crops) The above described crops are growing or are to grown on (Describe real estate) _____________________________________________.
5. (Check here ___ if collateral is goods which are or are to become fixtures, timber to cut, or minerals or the like (including oil and gas) or accounts to be financed at the wellhead or minehead of the well or mine). The legal description of the real estate is: ____________________________________________________________________,
and this Financing Statement is to be filed in the office where a mortgage on the real estate would be recorded. If the debtor does not have an interest of record, the name of the record owner is ___________________________________________.
6. Proceeds and products of collateral are also covered.
Signature of Secured Party Signature of Debtor