HomeMy WebLinkAbout01-2403 PARTIEG
DeMor Dame (last name first if individcel) and mai~ing address:
Deborah A Zeigler
622 Mil/race Court
Carlisle, PA 17013
Debtor name (last name first if individual) and mailing address:
Deblor name (last name first if individual) arid mailing address:
ta
lb
~ured Party(icG) name(s) {last name first if individual) and address for -
sscurJty interest information:
American General CDC
6 S. Hanover Street
Carlisle. PA 17013 2
AesJgnee(s) of Secured Party name{s) (last name first if individual) and
address for eecur~ interest information:
FINANCING STATEMENT
Uniform Cammorcial Code Fona UCC-1
IMPORTANT - Pleees read i~as on
Filing No. (stamped by filing officer): Dale, Time, Filing Office (stamped by filing officer):
This Financing Statement is presented/or filing pursuant to ~orm Commereiai~-~de, and is
to be filed with the (check applicePle box:
[] Secre of ne C0mm0.we,tb
~ Prothonotary of Ck.~berl~nd ~ '* ~unty.
[] reel estate records of
unty.
Nltrnber of Additional Sheets (if any): 7
Optional Special IdentiEcetion (Max. 10 characters):
COLLATERAL
Identify coflof~ai by item aed/or type:
See Attached Invoice
AA06249 Table w/4 AA02011 Chairs Veneer Set LT.
2a
Gpecisl *r,/pee of Padiee (oheck if applicable):
[] The terms "Debtor" and "Secured Party" mean "Lessee" and "Lessor,"
respectively.
[] The terms "Debtor" and "Secured Party" mean "'Consignee" and
"Consignor," respectively·
[] Debtor is a Transmitting Utility.
3
SECURED PARTY SIGNATURE(S)
this statement is filed with only t~e Secured Party's signature to perfect s
ecurity interest in collateral (check applicable box(ss)).
· [] acquired after a change of name, identity or corporate structure of the
Debtor·
· [] as to which the filing has leaped.
already subject to a security interest in another county in Pennsylvania -
[] when the collateral was moved to this county.
[] when the Debtor's residence or place of business was moved to
this county.
already subiect to a security interest in another iarisdiction
[] when the colfateral was moved to Pennsylvania·
[] when the Debtor's location was moved to Pennsylvania.
~which is proceeds of the collataral described in block g, in which a
[] (check only if desired) Products of the collateral are also covered· 9
Idantffy related real estate, if applicable: The collateral is, or includes (check appropriate box{es)
a. [] crops growing or to be grown on -
b. [] goods which are or are to become fixtures on -
c. [] minerals or the like {including oil and gas) ss extracted on -
d. [] accounts resulting from the sale of minarals or the like (incl~ing oil and gas) at the
wellhead or minehead on -
the following real estate:
Street Address:
Described at: Book of (check one) [] Deeds []Mortgages, at Page{s) __
for __ County. Uniform Parcel identifier
[] Described on Additional Sheet·
Name of record owner (required only if no Debtor has an interest of record): 10
l~Signature(s):
la
DEBTOR SIGNATURE{S)
security interest was previously perfected {also describe proceeds in
block 9, if purchased with cash proceeds and not adeduately described
on the original finsncing statement).
Secured Party Signature(s)
{required only if pox(es)/s check above):
RETURN RECEIPT TO:
American General CDC
6 S. Hanover Street
Carlisle, PA 17013
fl
AR[3 FORM - FORM UCCd
INSTRUCTIONS
1. PLEASE TYPE OR PRINT all informatior~ i~ black.
2. FOR FIUNGS WITH THE DEPARTMENT OF STATE YOU MUST USE THIS FORM or a standard form
approved by the Secretary ol the Commonwealth. if additior~al sheets are r~eeded due to limited
space on this form, use additional 8 1/2 X 11 inch sheets. Be sure to indicate the nun~ber of sheets
(if any) in block 7. if the security agreement rtseif is filed as the financing statement, ~t must be filed
with this form properly completed and with conformed signatures (such as '/s/(name of signer)').
THIS FORM MAY NOT BE ACCEPTABLE FOR FLUNG IN ALL COUNTIES. PLEASE CHECK VVlTH
THE PROTHONOTARY OF THE COUNTY VvI'rH REGARD TO ITS ACCEPTABILITY Al,ID USE.
COMPL.t:iu_ THE FORM CAREFULLY. Follow any instructions provided, and onb/ check boxes that
apply to the transaction or this filing. List only 1 debtor name per block 1, la & lb. Be sure to leave
block 5 blank, for completion by the filing officer. To help you identify this filing, a special
identification number or letter code of up to 10 characters may be entered in block 8. Any such
identification number or letter code is entirely optional, and is only for the convenience of the filer.
This number or letter code wi~t appear on the receipt for this form that you will receive from the
filing office of the Department of State.
4. FLUNG FEES must be paid at the time of filing. The fee for filing this form with one (1) debtor name
with the Department of State is $12.00. For each additional name listed on the UCC-1 form include
an additional $12.00 with the filing fee. There is no extra charge for additional sheets filed with this
form. For filings with the Department of State, make your check payable to 'PA Department of
State'. Separate checks are required for each filing. Local filings are to be made with the appropriate
county office. Please check with the Prothonotary of each county with regard to local filing
instructions and fees.
k~L OR DELIVER this form to the appropriate state and/or county office(s) for filing. Be sure to
indicate the filing office in block 6, and remember to include your check to cover required filing fees.
Filings with the Department of State are to be addressed to 'Uniform Commercial Code, Department
ol State, Han~rg, PA 17120'. You are advised to keep a copy of this Form UCC-1 for your own
records.
6. A RECEIPT for this form, bearing the date time, filing number, and any special identification number
or letter code entered in block 8, will be returned to you by the Department of State. The receipt
for this form will be mailed to the name and address listed in block 12.
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C~ATRS VE~EE~ SET LT,