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HomeMy WebLinkAbout01-0975 PARTIES DE BTOR name (Last name first if Individual) and mailing address: Gaughen Insurance, Inc. 1023 Mumma Road Lemoyne, PA 17043 DEBTOR name (Last name first if Individual) and mailingaddress: DE BTOR name (Last name first if Individual)and mailing address: SECURED PARTY(les) name(s) (last name first if individual) and address for security intel'est In form&tlon: Mid Pe~'m Bank 4622 Carlisle Pike Mechanicsburg, PA 17055 2 ASSIGNEE(B) OF SECURED PARTY name(s)(last name first if individual)and address for security interest Information: FINANCING STATEMENT UNIFORM COMMERCIAL CODE FORM UCC-1 FILING NO, (stamped by filing officer): This FINANCING STATE MENT s presen ed or filing pursuant t~we4Jn ~oi'm Conl~3erd~[ ~i~ s to be filed w~th the (check applicable boX): ~ 7~x~ ? , .~ i/~ .., ~ NUMBER OF ADDITIONAL SHEETS (if any): 7 COLLATERAL All Inventory, Chattel Paper, Accounts, Equipment and General Intangibles; whether any of the foregoing is owned now or acquired later; all accessions, additions, replacements, and substitutions relating to any of the foregoing; all records of any kind relating to any of the foregoing; all proceeds relating to any of the foregoing (including insurance, general intangibles and other accounts proceeds).. SPECIAL TYPES OF PARTIES (Check if applicable): [~ DeDtor is a Transmltting Unllty SECURED PARTY SIGNATURE(S) 2a respectively. The terms 'Debtor' and 'secured P~'ty' mean 'Consignee' and "Consignor', respectively. THIS STATE MENT IS FILE D WiTH ONLY THE SECURE D PARTY'S BIG NATURE to perfect a security interest in collateral (check applicable a. [] ACOUlRED AFTER A CHANGE OF NAME, IDENT[TY OR CORPORATE STRUCTURE of the Debtor. b. [] as to which t he riling has lapsed. c. already suDject to a security interest in ANOTHER COUNTY in Pennsylvania ] when the COLLATERAL WAS MOVED to this county. ] when the DEBTOR'S RBalDENCE OR PLACE OF BUSINESS WAS MOVE D to this courtty. d. already subject to a security interest In ANOTHER JURISDICTION -- when the COLLATERAL WAS MOVED to Pennsylvania. ] when the DEBTOR'S REEIDENCE OR PLACE OF BUSINEeS WAS MOVED to Pennsylvania. [] which Is PROCEE DS of the collat ertl described In block g in which a security interest was previously perfected (also describe p~'oCeeds in blCCk 9, if purchased with cash proceeds and not adequately described on the original financing statement). ] (check only if desired)Products of the collateral are alsocovered. 9 IDENTIFY RELATE D REAL ESTATE, if applicable. The collar oral is, or Includes (check appropriate box(es)) -- a. [] CROPS~rowlngortobe~ownon-- b. [] goods which are fo become FIXTURE on -- c. [] MINERALSorthellke(Includlngollandga$)asextractedon-- d. [] ACCOUNTSRESULTINGFROMTHESALEOFMINERALSOrthelIke(includlngoilandgas at the wellhead or minehead on -- the f ollowlng real estate: STREET ADDRESS: DESCRIBEAT:Book of (check one) L J Deeds~J Mortgages, at Page(s) for County. Uniform Parcel Identifier ] Describe on Addlnonal Sheet NAME OF RECORD OWNER (required only If no Debtor has an interest of record): DEBTOR SIGNATURE(S) Theodore 9~[~Ndet~ SECURED PARTY SIGNATURE(S: requredony fbo~(es scheckedabove: lb STANDARD FORM - FORM UCC-1 (7-89) Approved by the Secretary of the Commonwealth of Pennsylvania RETURN RECEIPT TO: Mid Penn Bank CarllNe Pike Office 4622 Carlisle Pike FILING OFFICE ORIGINAU-*t NOTE - This page will not be returned by the Department of State.