U.C.C. Financing Statement

This Financing Statement is presented for filing under the Uniform Commercial Code as adopted in ________________________________ [name of your state].
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Name of Borrower: ___________________________________________________
Address of Borrower: ________________________________________________
Name of Lender/Secured party: ________________________________________
Address of Lender/Secured party: ______________________________________
The term Borrower refers to one or more borrowers. If there is more than one borrower, they agree to be jointly and severally liable. The term Lender refers to any person who legally holds this note, including a buyer in due course.

The property listed as collateral in the security agreement is as follows [identify or describe]:
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This Financing Statement secures the following debt:
Promissory note dated: ________________________________
Amount of debt: ______________________________________
Payback due date: ____________________________________
All other terms and conditions are stated in the promissory note, which is attached.

Borrower's signature: ________________________________
Print name: ________________________________________
Date: ________________________________
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(For Use of the Filing Officer)
Date of filing: __________________	Time of filing: ______________________
File number and address of filing office: __________________________________________