2011 Indiana Code
TITLE 26. COMMERCIAL LAW
ARTICLE 1. UNIFORM COMMERCIAL CODE
CHAPTER 1.5. UCC FORMS

IC 26-1-1.5
Chapter 1.5. UCC Forms

IC 26-1-1.5-1 Version a
Use of forms
Note: This version of section effective until 7-1-2013. See also following version of this section, effective 7-1-2013.
Sec. 1. The forms in this chapter may be used for filings under IC 26-1.
As added by P.L.57-2000, SEC.14.

IC 26-1-1.5-1 Version b
Use of forms
Note: This version of section effective 7-1-2013. See also preceding version of this section, effective until 7-1-2013.
Sec. 1. The forms in IC 26-1-9.1-521 may be used for filings under IC 26-1.
As added by P.L.57-2000, SEC.14. Amended by P.L.54-2011, SEC.2.

IC 26-1-1.5-2 Version a
Financing statement; financing statement amendment
Note: This version of section effective until 7-1-2013. See also following repeal of this section, effective 7-1-2013.
Sec. 2. The following forms are set forth below:
(1) IC 26-1-9.1 financing statement.
(2) IC 26-1-9.1 financing statement amendment.
Figure
Graphic file number 0 named . with height 17 p and width 113 p Left aligned Figure
Graphic file number 1 named . with height 8 p and width 114 p Left aligned Figure
Graphic file number 2 named . with height 8 p and width 114 p Left aligned Figure
Graphic file number 3 named . with height 17 p and width 113 p Left aligned

UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front and back)CAREFULLY
Figure
Graphic file number 4 named . with height 84 p and width 164 p Left aligned
A. NAME & PHONE OF CONTACT FILER (optional)
B. SEND ACKNOWLEDGMENT TO: (Name and Address)

. .

. . THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (1a or 1b) do not abbreviate or combine names.
Figure
Graphic file number 5 named . with height 33 p and width 4 p Left aligned
1a. ORGANIZATION'S NAME
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Graphic file number 6 named . with height 53 p and width 4 p Left aligned Figure
Graphic file number 7 named . with height 33 p and width 4 p Left aligned Figure
Graphic file number 8 named . with height 37 p and width 7 p Left aligned OR

1b. INDIVIDUAL'S NAME FIRST NAME MIDDLE NAME SUFFIX

Figure
Graphic file number 9 named . with height 19 p and width 4 p Left aligned 1c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY
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Graphic file number 10 named . with height 25 p and width 4 p Left aligned Figure
Graphic file number 11 named . with height 24 p and width 4 p Left aligned Figure
Graphic file number 12 named . with height 24 p and width 4 p Left aligned

Figure
Graphic file number 13 named . with height 13 p and width 10 p Left aligned ADD'L INFO RE 1e. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION 1g. ORGANIZATION ID#, if any
ORGANIZATION
DEBTOR NONE
Figure
Graphic file number 14 named . with height 33 p and width 4 p Left aligned 2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME -insert only one debtor name (2a or 2b) - do not abbreviate or combine names
2a. ORGANIZATION'S NAME

Figure
Graphic file number 15 named . with height 54 p and width 4 p Left aligned Figure
Graphic file number 16 named . with height 34 p and width 4 p Left aligned Figure
Graphic file number 17 named . with height 34 p and width 4 p Left aligned OR
2b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
Figure
Graphic file number 18 named . with height 19 p and width 4 p Left aligned

2c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

Figure
Graphic file number 19 named . with height 24 p and width 4 p Left aligned Figure
Graphic file number 20 named . with height 24 p and width 4 p Left aligned Figure
Graphic file number 21 named . with height 24 p and width 4 p Left aligned
Figure
Graphic file number 22 named . with height 13 p and width 10 p Left aligned ADD'L INFO RE 2e. TYPE OF ORGANIZATION 2f. JURISDICTION OF ORGANIZATION 2g. ORGANIZATION ID#, if any
ORGANIZATION
DEBTOR NONE

Figure
Graphic file number 23 named . with height 33 p and width 4 p Left aligned 3. SECUR ED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - insert only one secured part name (3a or 3b)

3a. ORGANIZATION'S NAME

Figure
Graphic file number 24 named . with height 33 p and width 4 p Left aligned Figure
Graphic file number 25 named . with height 33 p and width 4 p Left aligned Figure
Graphic file number 26 named . with height 34 p and width 4 p Left aligned OR
3b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
Figure
Graphic file number 27 named . with height 19 p and width 4 p Left aligned

3c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY


4. This FINANCING STATEMENT covers the following collateral:
Figure
Graphic file number 28 named . with height 9 p and width 7 p Left aligned Figure
Graphic file number 29 named . with height 9 p and width 7 p Left aligned Figure
Graphic file number 30 named . with height 9 p and width 7 p Left aligned Figure
Graphic file number 31 named . with height 9 p and width 7 p Left aligned Figure
Graphic file number 32 named . with height 9 p and width 7 p Left aligned Figure
Graphic file number 33 named . with height 9 p and width 7 p Left aligned
5. ALTERNATIVE DESIGNATION (if applicable). LESSEE/LESSOR CONSIGNEE/CONSIGNOR BAILEE/BAILOR SELLER/BUYER AG. LIEN NON-UCC FILING
Figure
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Graphic file number 35 named . with height 17 p and width 4 p Left aligned
Figure
Graphic file number 36 named . with height 9 p and width 7 p Left aligned Figure
Graphic file number 37 named . with height 9 p and width 7 p Left aligned Figure
Graphic file number 38 named . with height 9 p and width 7 p Left aligned 6. This FINANCING STATEMENT is to be filed (for record) (or recorded) in the REAL 7. Check to REQUEST SEARCH REPORTS(S) on Debtor(s)
ESTATE RECORDS Attached Addendum [if applicable] [ADDITIONAL FEE] [optional] All Debtors Debtor 1 Debtor 2

8. DEBTOR SIGNATURE

FILING OFFICE COPY _NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 04/23/98)

UCC FINANCING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS (front and back)CAREFULLY

9. NAME OF FIRST DEBTOR(1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATION'S NAME

Figure
Graphic file number 39 named . with height 18 p and width 5 p Left aligned Figure
Graphic file number 40 named . with height 18 p and width 5 p Left aligned
9b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME, SUFFIX

10. MISCELLANEOUS:

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME -insert only one debtor name (11a or 11b) - do not abbreviate or combine names
Figure
Graphic file number 41 named . with height 35 p and width 4 p Left aligned

11a. ORGANIZATION'S NAME

Figure
Graphic file number 42 named . with height 39 p and width 4 p Left aligned Figure
Graphic file number 43 named . with height 39 p and width 4 p Left aligned Figure
Graphic file number 44 named . with height 54 p and width 4 p Left aligned OR
11b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

Figure
Graphic file number 45 named . with height 24 p and width 43 p Left aligned
11c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

Figure
Graphic file number 46 named . with height 21 p and width 43 p Left aligned Figure
Graphic file number 47 named . with height 20 p and width 43 p Left aligned
Figure
Graphic file number 48 named . with height 13 p and width 10 p Left aligned ADD'L INFO RE 11e. TYPE OF ORGANIZATION 11f. JURISDICTION OF ORGANIZATION 11g. ORGANIZATION ID#, if any
ORGANIZATION
Figure
Graphic file number 49 named . with height 10 p and width 10 p Left aligned Figure
Graphic file number 50 named . with height 41 p and width 4 p Left aligned Figure
Graphic file number 51 named . with height 11 p and width 10 p Left aligned DEBTOR NONE
12. ADDITIONAL SECUR ED PARTY'S or ASSIGNOR S/P'S name - insert only one name (12a or 12b)
12a. ORGANIZATION'S NAME

Figure
Graphic file number 52 named . with height 281 p and width 4 p Left aligned Figure
Graphic file number 53 named . with height 32 p and width 4 p Left aligned Figure
Graphic file number 54 named . with height 33 p and width 4 p Left aligned OR
12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
Figure
Graphic file number 55 named . with height 18 p and width 4 p Left aligned
12c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY
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Graphic file number 56 named . with height 7 p and width 7 p Left aligned Figure
Graphic file number 57 named . with height 7 p and width 7 p Left aligned
Figure
Graphic file number 58 named . with height 7 p and width 7 p Left aligned 13. This FINANCING STATEMENT covers timber to be cut or as-extracted 16. Additional collateral description:
collateral, or is filed as a fixture filing.
14. Description of real estate:

15. Name and address of a RECORD OWNER of above-described real estate
(if Debtor does not have a record interest):
17. Check only if applicable and check only one box.
Figure
Graphic file number 59 named . with height 7 p and width 7 p Left aligned Figure
Graphic file number 60 named . with height 7 p and width 7 p Left aligned Figure
Graphic file number 61 named . with height 7 p and width 7 p Left aligned Debtor is a Trust or Trustee acting with respect to property held in trust or Decedent's Estate

18. Check only if applicable and check only one box.
Figure
Graphic file number 62 named . with height 7 p and width 7 p Left aligned Figure
Graphic file number 63 named . with height 7 p and width 7 p Left aligned Debtor is a TRANSMITTING UTILITY
Figure
Graphic file number 64 named . with height 7 p and width 7 p Left aligned Filed in connection with a Manufactured-Home Transaction _effective 30 years
Filed in connection with a Public-Finance Transaction _effective 30 years

FILING OFFICE COPY_NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad)(REV. 04/23/98)
END OF IC 26-1-9.1 FINANCING STATEMENT Figure
Graphic file number 65 named . with height 17 p and width 113 p Left aligned Figure
Graphic file number 66 named . with height 8 p and width 114 p Left aligned Figure
Graphic file number 67 named . with height 8 p and width 114 p Left aligned Figure
Graphic file number 68 named . with height 17 p and width 113 p Left aligned


UCC FINANCING STATEMENT AMENDMENT
Figure
Graphic file number 69 named . with height 85 p and width 178 p Left aligned FOLLOW INSTRUCTIONS (front and back)CAREFULLY
A. NAME & PHONE OF CONTACT FILER (optional)
Figure
Graphic file number 70 named . with height 5 p and width 178 p Left aligned
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
. .

. . THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
Figure
Graphic file number 71 named . with height 14 p and width 11 p Left aligned 1a. INITIAL FINANCING STATEMENT FILE # 1b. This FINANCING STATEMENT AMENDMENT is
to be filed (for record) (or recorded) in the
Figure
Graphic file number 72 named . with height 11 p and width 9 p Left aligned REAL ESTATE RECORDS.
Figure
Graphic file number 73 named . with height 11 p and width 9 p Left aligned 2. TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of the Secured party authorizing this Termination Statement
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Graphic file number 74 named . with height 11 p and width 9 p Left aligned 3. CONTINUATION: Effectiveness of the Financing Statement identified above with respect to security interest(s) of the Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law.
Figure
Graphic file number 75 named . with height 11 p and width 9 p Left aligned Figure
Graphic file number 76 named . with height 11 p and width 9 p Left aligned 4. ASSIGNMENT (full or partial): Give name of assignee in item 7a or 7b and address of assignee in item 9.
5. AMENDMENT (PARTY INFORMATION): This Amendment effects Debtor or Secured party of record. Check only one of these boxes.
Figure
Graphic file number 77 named . with height 11 p and width 9 p Left aligned Figure
Graphic file number 78 named . with height 11 p and width 9 p Left aligned Also check one of the following three boxes and provide appropriate information in items 6 and/or 7.
Figure
Graphic file number 79 named . with height 11 p and width 9 p Left aligned CHANGE name and/or address: Give current record name in item 6 or 6b; also give new DELETE name: give record name ADD name: Complete item 7a or 7b and also
Name (if name change) in item 7a or 7b and./or new address (if address change) in item 7c to be deleted in item 6a or 6b. Item 7c; also complete 7e-7g (if applicable).
Figure
Graphic file number 80 named . with height 31 p and width 4 p Left aligned 6 6. CURRENT RECORD INFORMATION:
6a. ORGANIZATION'S NAME
Figure
Graphic file number 81 named . with height 18 p and width 4 p Left aligned Figure
Graphic file number 82 named . with height 18 p and width 4 p Left aligned Figure
Graphic file number 83 named . with height 18 p and width 4 p Left aligned OR
6b. INDIVIDUAL'S NAME FIRST NAME MIDDLE NAME SUFFIX

Figure
Graphic file number 84 named . with height 34 p and width 4 p Left aligned 7. CHANGED (NEW) OR ADDED INFORMATION:
7a. ORGANIZATION'S NAME
Figure
Graphic file number 85 named . with height 36 p and width 4 p Left aligned Figure
Graphic file number 86 named . with height 37 p and width 4 p Left aligned Figure
Graphic file number 87 named . with height 54 p and width 4 p Left aligned OR
7b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

7c. ADDRESS CITY STATE POSTAL CODE COUNTRY

Figure
Graphic file number 88 named . with height 20 p and width 4 p Left aligned Figure
Graphic file number 89 named . with height 20 p and width 4 p Left aligned Figure
Graphic file number 90 named . with height 20 p and width 4 p Left aligned Figure
Graphic file number 91 named . with height 11 p and width 9 p Left aligned ADD'L INFO RE 7e. TYPE OF ORGANIZATION 7f. JURISDICTION OF ORGANIZATION 7g. ORGANIZATION ID#, if any
ORGANIZATION
DEBTOR NONE
Figure
Graphic file number 92 named . with height 11 p and width 9 p Left aligned Figure
Graphic file number 93 named . with height 11 p and width 9 p Left aligned Figure
Graphic file number 94 named . with height 11 p and width 9 p Left aligned Figure
Graphic file number 95 named . with height 11 p and width 9 p Left aligned 8. AMENDMENT (COLLATERAL CHANGE): Check only one box.
Describe collateral Deleted or Added, or give entire restated collateral description, or describe collateral assigned.

Figure
Graphic file number 96 named . with height 10 p and width 9 p Left aligned 9. NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT (name of assignor, if this is an Assignment). If this is an Amendment authorized by a Debtor which adds collateral or adds the authorizing Debtor, or if this is a Termination authorized by a Debtor, check here and enter name of DEBTOR authorizing this Amendment.
Figure
Graphic file number 97 named . with height 36 p and width 4 p Left aligned
9a. ORGANIZATION'S NAME

Figure
Graphic file number 98 named . with height 20 p and width 4 p Left aligned Figure
Graphic file number 99 named . with height 20 p and width 4 p Left aligned Figure
Graphic file number 100 named . with height 20 p and width 4 p Left aligned OR
9b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX

10. DEBTOR SIGNATURE


FILING OFFICE COPY _NATIONAL UCC FINANCING STATEMENT AMENDMENT(FORM UCC3) (REV. 04/23/98)

UCC FINANCING STATEMENT AMENDMENT ADDENDUM
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
11. INITIAL FINANCING STATEMENT FILE # (same as item 1a on amendment form)

12. NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on Amendment form)
12a ORGANIZATION'S NAME
Figure
Graphic file number 101 named . with height 22 p and width 4 p Left aligned Figure
Graphic file number 102 named . with height 22 p and width 4 p Left aligned OR
12b INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME, SUFFIX

13. Use this space for additional information

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

FILING OFFICE COPY _NATIONAL UCC FINANCING STATEMENT AMENDMENT ADDENDUM(FORM UCC3Ad) (REV. 04/23/98)

END OF IC 26-1-9.1 FINANCING STATEMENT AMENDMENT
As added by P.L.57-2000, SEC.14.
IC 26-1-1.5-2 Version b
Repealed
(Repealed by P.L.54-2011, SEC.28.)
Note: This repeal of section effective 7-1-2013. See also preceding version of this section, effective until 7-1-2013.