Rhode Island General Laws Title 6A. Uniform Commercial Code § 6A-9-521. Uniform form of written financing statement and amendment

1. DEBTOR'S NAME: Provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor's name); if any part of the Individual Debtor's name will not fit in line 1b, leave all of item 1 blank, check here ( and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)

1a. ORGANIZATION'S NAME _________________________________________________

or

1b. INDIVIDUAL'S SURNAME _________________________________________________

FIRST PERSONAL NAME _____________________________________________________

ADDITIONAL NAME(S)/INITIAL(S) ______________________________________________

SUFFIX __________

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 part of the Debtor's name); if any part of the Individual Debtor's name will not fit in line 2b, leave all of item 2 blank, check here ( ) and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)

2a. ORGANIZATION'S NAME _________________________________________________

or

2b. INDIVIDUAL'S SURNAME _________________________________________________

FIRST PERSONAL NAME _________________________________________________

ADDITIONAL NAME(S)/INITIAL(S)

SUFFIX __________

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 _________________________________________________

or

3b. INDIVIDUAL'S SURNAME _________________________________________________

FIRST PERSONAL NAME __________

ADDITIONAL NAME(S)/INITIAL(S)

SUFFIX __________

3c. MAILING ADDRESS _____

CITY _____________________ STATE _____ POSTAL CODE _______ COUNTRY ________

4. COLLATERAL: The financing statement covers the following collateral:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

5. Check only if applicable and check only one box: Collateral is ( ) held in a Trust (see UCC1Ad, item 17 and Instructions) ( ) being administered by a Decedent's Personal Representative

6a. Check only if applicable and check only one box:

( ) Public-Finance Transaction ( ) Manufactured-Home Transaction ( ) A Debtor is a Transmitting Utility

6b. Check only if applicable and check only one box:

( ) Agricultural Lien ( ) Non-UCC Filing

7. ALTERNATIVE DESIGNATION (if applicable): ( ) Lessee/Lessor ( ) Consignee/Consignor ( ) Seller/Buyer ( ) Bailee/Bailor ( ) Licensee/Licensor

8. OPTIONAL FILER REFERENCE DATA:

_____________________________________________________________________________

UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11)

UCC FINANCING STATEMENT ADDENDUM

FOLLOW INSTRUCTIONS

9. NAME OF FIRST DEBTOR: Same as 1a or 1b on Financing Statement; if line 1b was left blank because Individual Debtor name did not fit, check here ( )

9a. ORGANIZATION'S NAME

or

9b. INDIVIDUAL'S SURNAME

FIRST PERSONAL NAME _______________________________________________________

ADDITIONAL NAME(S)/INITIAL(S) ______________________________________________

SUFFIX __________

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

10. DEBTOR'S NAME: Provide (10a or 10b) only one additional Debtor name or Debtor name that did not fit in line 1b or 2b of the Financing Statement (Form UCC1) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor's name) and enter the mailing address in line 10 c

10a. ORGANIZATION'S NAME

or

10b. INDIVIDUAL'S SURNAME ________________________________________________

INDIVIDUAL'S FIRST PERSONAL NAME

INDIVIDUAL'S ADDITIONAL NAME(S)/INITIAL(S)

SUFFIX __________

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

or

11b. 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: ( ) covers timber to be cut ( ) covers as-extracted collateral ( ) is filed as a fixture filing

15. Name and address of a RECORD OWNER of real estate described in item 16 (if Debtor does not have a record interest):

16. Description of real estate:

17. MISCELLANEOUS: