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  1.  
  2.                        FINANCING STATEMENT
  3. ____________________________________________________________
  4. Debtor (Last Name First/Individual)   Social Security Number
  5. ____________________________________________________________
  6. Mailing Address              City, State            Zip Code
  7. ____________________________________________________________
  8. Additional Debtor - (If Any)          Social Security Number
  9. ____________________________________________________________
  10. Mailing Address              City, State            Zip Code
  11. ____________________________________________________________
  12. Debtor's Trade Names or Styles            Federal Tax Number
  13. ____________________________________________________________
  14. Secured Party                            Social Security No.
  15. Name                                     Federal Tax No. or
  16. Address                                  Bank Transit and
  17. City, State                              A.B.A. No.
  18. Zip Code
  19. ____________________________________________________________
  20. Assignee of Secured Party                Social Security No.
  21. Name                                     Federal Tax No. or
  22. Address                                  Bank Transit and
  23. City, State                              A.B.A. No.
  24. Zip Code
  25. ____________________________________________________________
  26. This FINANCING STATEMENT covers the following types or
  27. items of property (include description of real property
  28. on which located and owner of record when required).
  29.  
  30. ____________________________________________________________
  31. Products of Collateral are also covered Yes______No______
  32. ____________________________________________________________
  33. Debtor is a "Transmitting Utility"      Yes______No______
  34. ____________________________________________________________
  35.                                              Date:
  36. Signature(s) of Debtor(s)
  37. _____________________________________________________________
  38. Type or Print Name of Debtor
  39. _____________________________________________________________
  40. Signature(s) of Secured Party(ies)
  41. _____________________________________________________________
  42. Type or Print Name of Secured Party
  43. _____________________________________________________________
  44. Return Copy to:
  45.  
  46. _____________________________________________________________
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