ucc3adFILING OFFICE COPY — UCC FINANCING STATEMENT AMENDMENT ADDENDUM (Form UCC3Ad) (Rev. 04/20/11)
UCC FINANCING STATEMENT AMENDMENT ADDENDUM
FOLLOW INSTRUCTIONS
12. NAME OF PARTY AUTHORIZING THIS AMENDMENT: Same as item 9 on Amendment form
11. INITIAL FINANCING STATEMENT FILE NUMBER: Same as item 1a on Amendment form
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
OR
12a. ORGANIZATION'S NAME
12b. INDIVIDUAL'S SURNAME
ADDITIONAL NAME(S)/INITIAL(S)
FIRST PERSONAL NAME
13. 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 item 13): Provide only
one Debtor name (13a or 13b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor’s name); see Instructions if name does not fit
SUFFIX
OR
13a. ORGANIZATION'S NAME
14. ADDITIONAL SPACE FOR ITEM 8 (Collateral):
17. Description of real estate:
16.Name and address of a RECORD OWNER of real estate described in item 17
(if Debtor does not have a record interest):
15.This FINANCING STATEMENT AMENDMENT:
covers timber to be cut covers as-extracted collateral is filed as a fixture filing
13b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S)SUFFIX
18. MISCELLANEOUS:
Instructions for UCC Financing Statement Amendment Addendum (Form UCC3Ad)
Please type or laser-print this form. Be sure it is completely legible. Read and follow all Instructions; use of the correct name for the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give
legal advice.
ITEM INSTRUCTIONS
11.File Number. Enter file number of initial financing statement as shown in item 1a of Amendment (Form UCC3) to which this Amendment
Addendum relates.
12.Name of Authorizing Party. Enter information exactly as shown in item 9 on Amendment (Form UCC3).
13.Name of Debtor on related Financing Statement. If this Amendment (Form UCC3) is to be filed in the real estate records or in any other filing
office where the name of a current Debtor of record is required for indexing purposes, enter Debtor name in item 13a or 13b. Item 13 is intended
to cross-reference the Amendment (Form UCC3) and Amendment Addendum with the related Financing Statement (Form UCC1). If more than
one current Debtor, enter additional name(s) in item 14 or on additional Amendment Addendum (Form UCC3Ad). Do not use item 13 to change,
add, or delete a Debtor name.
14.Additional Space for Item 8 (Collateral). If space in item 8 of Amendment (Form UCC3) is insufficient or additional information must be provided,
enter additional information in item 14 or attach additional page(s) and incorporate by reference in item 14 (e.g., See Exhibit A). Do not include
social security numbers or other personally identifiable information.
15-17.Real Estate Record Information. If this Amendment (Form UCC3) is to be filed in the real estate records, complete the required information
(items 15, 16, and 17). If this Amendment (Form UCC3) covers timber to be cut, covers as-extracted collateral, and/or is filed as a fixture filing,
check appropriate box in item 15. If the Debtor does not have an interest of record, enter the name and address of the record owner in item 16.
Provide a sufficient description of real estate in accordance with the applicable law of the jurisdiction where the real estate is located in item 17.
If space in items 16 or 17 is insufficient, attach additional page(s) and incorporate by reference in items 16 or 17 (e.g., See Exhibit A), and continue
the real estate information. Do not include social security numbers or other personally identifiable information.
18.Miscellaneous. Under certain circumstances, additional information not provided on the Financing Statement Amendment (Form UCC3) may
be required. Also, some states have non-uniform requirements. Use this space or attach additional page(s) and incorporate by reference in item
18 (e.g., See Exhibit A) to provide such additional information or to comply with such requirements; otherwise, leave blank. Do not include social
security numbers or other personally identifiable information.