2012 Revised Code of Washington
Title 62A - UNIFORM COMMERCIAL CODE
9A Secured transactions; sales of accounts, contract rights and chattel paper.
62A.9A-521 Uniform form of written financing statement and amendment.

RCW 62A.9A-521 Uniform form of written financing statement and amendment. (Effective until July 1, 2013.)

(a) Initial financing statement form. A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in RCW 62A.9A-516(b):

UCC FINANCING STATEMENT

FOLLOW INSTRUCTIONS (front and back) CAREFULLY

A.

NAME & PHONE OF CONTACT AT 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

1a.

ORGANIZATION'S NAME

OR

1b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

1c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

1d. TAX ID #: SSN OR EIN

ADD'L INFO RE ORGANIZATION DEBTOR

1e. TYPE OF ORGANIZATION

1f. JURISDICTION OF ORGANIZATION

1g. ORGANIZATIONAL ID #, If any

NONE

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

OR

2b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

2c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

2d. TAX ID #: SSN OR EIN

ADD'L INFO RE ORGANIZATION DEBTOR

2e. TYPE OF ORGANIZATION

2f. JURISDICTION OF ORGANIZATION

2g. ORGANIZATIONAL ID #, If any

NONE

3.

SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) - insert only one secured party name (3a or 3b)

3a.

ORGANIZATION'S NAME

OR

3b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

3c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

4.

This FINANCING STATEMENT covers the following collateral:

5.

ALTERNATIVE DESIGNATION [if applicable]:

LESSEE/LESSOR

CONSIGNEE/CONSIGNOR

BAILEE/BAILOR

SELLER/BUYER

AG. LIEN

NON-UCC FILING

6.

This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS. Attach Addendum [if applicable]

7.

Check to REQUEST SEARCH REPORT(S) on Debtor(s)

All Debtors

Debtor 1

Debtor 2

[Additional Fee] [optional]

8.

OPTIONAL FILER REFERENCE DATA

NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29/98)

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

OR

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 name (11a or 11b) - do not abbreviate or combine names

11a.

ORGANIZATION'S NAME

OR

11b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

11c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

11d. TAX ID #: SSN OR EIN

ADD'L INFO RE ORGANIZATION DEBTOR

11e. TYPE OF ORGANIZATION

11f. JURISDICTION OF ORGANIZATION

11g. ORGANIZATIONAL ID #, If any

NONE

12.

ADDITIONAL SECURED PARTY'S or ASSIGNOR S/P'S NAME - insert only one name (12a or 12b)

12a.

ORGANIZATION'S NAME

OR

12b.

INDIVIDUAL'S LAST NAME

FIRST NAME

MIDDLE NAME

SUFFIX

12c.

MAILING ADDRESS

CITY

STATE

POSTAL CODE

COUNTRY

13.

This FINANCING STATEMENT covers timber to be cut or as-extracted collateral, or is filed as a fixture filing.

16. Additional collateral description:

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. 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. Debtor is a TRANSMITTING UTILITY Filed in connection with a Manufactured-Home Transaction - effective 30 years Filed in connection with a Public-Finance Transaction - effective 30 years

NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98)

     (b) Amendment form. A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in RCW62A.9A-516 (b):

UCC FINANCING STATEMENT AMENDMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A.	NAME & PHONE OF CONTACT AT FILER [optional]
B.	SEND ACKNOWLEDGMENT TO: (Name and Address)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1a.	INITIAL FINANCING STATEMENT FILE #						1b. This FINANCING STATEMENT AMENDMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS.
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.
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.
4.	ASSIGNMENT (full or partial): Give name of assignee in item 7a or 7b and address of assignee in item 7c; and also give name of assignor in item 9.
5.	AMENDMENT (PARTY INFORMATION): This Amendment affects Debtor or Secured Party of record. Check only one of these two boxes.
Also check one of the following three boxes and provide appropriate information in items 6 and/or 7.
CHANGE name and/or address: Give current record name in item 6a or 6b; also give new name (if name changed) in item 7a or 7b and/or new address (if address change) in item 7c.					DELETE name: Give record name to be deleted in item 6a or 6b.				ADD name: Complete item 7a or 7b, and also item 7c; also complete items 7d-7g (if applicable).
6.	CURRENT RECORD INFORMATION:
	6a.	ORGANIZATION'S NAME
OR
	6b.	INDIVIDUAL'S LAST NAME				FIRST NAME		MIDDLE NAME		SUFFIX
7.	CHANGED (NEW) OR ADDED INFORMATION:
	7a.	ORGANIZATION'S NAME
OR
	7b.	INDIVIDUAL'S LAST NAME				FIRST NAME		MIDDLE NAME		SUFFIX
7c.	MAILING ADDRESS			CITY		STATE		POSTAL CODE		COUNTRY
7d. TAX ID #: SSN OR EIN			ADD'L INFO RE ORGANIZATION DEBTOR		7e. TYPE OF ORGANIZATION		7f. JURISDICTION OF ORGANIZATION		7g. ORGANIZATIONAL ID #, If any		NONE
8.	AMENDMENT (COLLATERAL CHANGE): check only one box.
Describe collateral deleted or added, or give entire restated collateral description, or describe collateral assigned.
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.
	9a.	ORGANIZATION'S NAME
OR
	9b.	INDIVIDUAL'S LAST NAME				FIRST NAME		MIDDLE NAME		SUFFIX
10.	OPTIONAL FILER REFERENCE DATA
NATIONAL UCC FINANCING STATEMENT AMENDMENT (FORM UCC3) (REV. 07/29/98)
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
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
NATIONAL UCC FINANCING STATEMENT AMENDMENT ADDENDUM (FORM UCC3Ad) (REV. 07/29/98)

[2000 c 250 § 9A-521.]

     

RCW 62A.9A-521

Uniform form of written financing statement and amendment. (Effective July 1, 2013.)

(a) Initial financing statement form. A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in RCW62A.9A-516 (b):

UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS
A.	NAME & PHONE OF CONTACT AT FILER (optional)
B.	E-MAIL CONTACT AT FILER (optional)
C.	SEND ACKNOWLEDGMENT TO: (Name and Address)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1.	DEBTOR'S NAME - provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
	1a.	ORGANIZATION'S NAME
OR
	1b.	INDIVIDUAL'S SURNAME				FIRST PERSONAL NAME	ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR	SUFFIX
	1c.	MAILING ADDRESS			CITY	STATE	POSTAL CODE	COUNTRY
2.	DEBTOR'S NAME - provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
	2a.	ORGANIZATION'S NAME
OR
	2b.	INDIVIDUAL'S SURNAME				FIRST PERSONAL NAME	ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR	SUFFIX
	2c.	MAILING ADDRESS			CITY	STATE	POSTAL CODE	COUNTRY
3.	SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY) - provide only one secured party name (3a or 3b)
	3a.	ORGANIZATION'S NAME
OR
	3b.	INDIVIDUAL'S SURNAME				FIRST PERSONAL NAME	ADDITIONAL NAME(S)/INITIAL(S)	SUFFIX
	3c.	MAILING ADDRESS			CITY	STATE	POSTAL CODE	COUNTRY
4.	COLLATERAL: This Financing Statement covers the following collateral:
5.	Check only if applicable and check only one box:
Collateral is				held in Trust (see Instructions)
				being administered by a Decedent's Personal Representative.
6a.	Check only if applicable and check only one box:
	Public-Finance Transaction				Manufactured-Home Transaction		A Debtor is a Transmitting Utility
6b.	Check only if applicable and check only one box:
	Agricultural Lien				Non-UCC Filing
7.	ALTERNATIVE DESIGNATION (if applicable):
	Lessee/Lessor		Cosignee/Cosignor		Seller/Buyer	Bailee/Bailor	Licensee/Licensor
8.	OPTIONAL FILER REFERENCE DATA
[UCC FINANCING STATEMENT (FORM UCC1)] (REV. 09/30/10)
UCC FINANCING STATEMENT ADDENDUM
FOLLOW INSTRUCTIONS
9.	NAME OF FIRST DEBTOR (same as item 1a or 1b on Financing Statement)
	9a.	ORGANIZATION'S NAME
OR
	9b.	INDIVIDUAL'S SURNAME				FIRST PERSONAL NAME	ADDITIONAL NAME(S)/INITIAL(S)	SUFFIX
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
10.	ADDITIONAL DEBTOR'S NAME - provide only one Debtor name (10a or 10b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
	10a.	ORGANIZATION'S NAME (exact, full name, without any modifications)
OR
	10b.	INDIVIDUAL'S SURNAME				FIRST PERSONAL NAME	ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR	SUFFIX
	10c.	MAILING ADDRESS			CITY	STATE	POSTAL CODE	COUNTRY
11.	ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME - provide only one name (11a or 11b)
	11a.	ORGANIZATION'S NAME
OR
	11b.	INDIVIDUAL'S SURNAME				FIRST PERSONAL NAME	ADDITIONAL NAME(S)/INITIAL(S)	SUFFIX
	11c.	MAILING ADDRESS			CITY	STATE	POSTAL CODE	COUNTRY
12.	ADDITIONAL SPACE FOR ITEM 4 (Collateral)
13.	This FINANCING STATEMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS (if applicable)
14.	This FINANCING STATEMENT:
	covers timber to be cut				covers as-extracted collateral		is filed as a fixture filing
15.	Name and address of a RECORD OWNER of real estate described in item 16 (if Debtor does not have a record interest)
16.	Description of real estate
17.	Miscellaneous
[UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad)] (REV. 09/30/10)

     (b) Amendment form. A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in RCW62A.9A-516 (b):

UCC FINANCING STATEMENT AMENDMENT
FOLLOW INSTRUCTIONS
A.	NAME & PHONE OF CONTACT AT FILER (optional)
B.	E-MAIL CONTACT AT FILER (optional)
C.	SEND ACKNOWLEDGMENT TO: (Name and Address)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1a.	INITIAL FINANCING STATEMENT FILE NUMBER
1b.	This FINANCING STATEMENT AMENDMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS. Filer: attach Amendment Addendum (Form UCC3 Ad) and provide Debtor's name in item 13.
2.	TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to the security interest(s) of Secured Party authorizing this Termination Statement.
3.	ASSIGNMENT (full or partial): Provide name of Assignee in item 7a or 7b, and address of Assignee in item 7c and name of Assignor in item 9. For partial assignment, complete items 7 and 9 and also indicate affected collateral in item 8.
4.	CONTINUATION: Effectiveness of the Financing Statement identified above with respect to the security interest(s) of Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law.
5.	PARTY INFORMATION CHANGE: Check one of these two boxes: This Change affects Debtor or Secured Party of record
	AND
	Check one of these three boxes to:
	CHANGE name and/or address: Complete item 6a or 6b; and item 7a or 7b and item 7c.
	ADD name: Complete item 7a or 7b, and item 7c.
	DELETE name: Give record name to be deleted in item 6a or 6b.
6.	CURRENT RECORD INFORMATION: Complete for Party Information Change - provide only one name (6a or 6b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
	6a.	ORGANIZATION'S NAME
OR
	6b.	INDIVIDUAL'S SURNAME		FIRST PERSONAL NAME		ADDITIONAL NAME(S)/INITIAL(S)	SUFFIX
7.	CHANGED OR ADDED INFORMATION: Complete for Assignment or Party Information Change - provide only one name (7a or 7b) (use exact full name; do not omit, modify, or abbreviate any word in the Debtor's name)
	7a.	ORGANIZATION'S NAME
OR
	7b.	INDIVIDUAL'S SURNAME		FIRST PERSONAL NAME		ADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTOR	SUFFIX
	7c.	MAILING ADDRESS	CITY	STATE		POSTAL CODE	COUNTRY
8.	COLLATERAL CHANGE: Also check one of these four boxes:
	ADD collateral		DELETE collateral		RESTATE covered collateral		ASSIGN collateral
	Indicate collateral:
9.	NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT - provide only one name (9a or 9b) (name of assignor, if this is an Assignment). If this is an Amendment authorized by a DEBTOR, check here and provide name of authorizing Debtor
	9a.	ORGANIZATION'S NAME
OR
	9b.	INDIVIDUAL'S SURNAME		FIRST PERSONAL NAME		ADDITIONAL NAME(S)/INITIAL(S)	SUFFIX
10.	OPTIONAL FILER REFERENCE DATA
[UCC FINANCING STATEMENT AMENDMENT (FORM UCC3)] (REV. 09/30/10)
UCC FINANCING STATEMENT AMENDMENT ADDENDUM
FOLLOW INSTRUCTIONS
11.	INITIAL FINANCING STATEMENT FILE NUMBER (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
OR
	12b.	INDIVIDUAL'S SURNAME		FIRST PERSONAL NAME		ADDITIONAL NAME(S)/INITIAL(S)	SUFFIX
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
13.	Name of DEBTOR on related financing statement (Name of a current Debtor of record required for indexing purposes only in some filing offices - see Instruction for item 13 - insert only one Debtor name (13a or 13b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name)
	13a.	ORGANIZATION'S NAME
OR
	13b.	INDIVIDUAL'S SURNAME		FIRST PERSONAL NAME		ADDITIONAL NAME(S)/INITIAL(S)	SUFFIX
14.	ADDITIONAL SPACE FOR ITEM 8 (Collateral)
15.	This FINANCING STATEMENT AMENDMENT:
	covers timber to be cut			covers as-extracted collateral			is filed as a fixture filing
16.	Name and address of a RECORD OWNER of real estate described in item 17 (if Debtor does not have a record interest)
17.	Description of real estate
18.	MISCELLANEOUS:
UCC FINANCING STATEMENT AMENDMENT ADDENDUM (FORM UCC1) (REV. 09/30/10)

[2011 c 74 § 406; 2000 c 250 § 9A-521.]

Notes:

Application -- Effective date -- 2011 c 74: See notes following RCW 62A.9A-102.