FOLLOW INSTRUCTIONS (front and back) CAREFULLY
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A. NAME & PHONE OF CONTACT AT FILER [optional] |
THE ABOVE SPACE IS FOR SECURITY REGISTRY USE ONLY | |||
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B. SEND ACKNOWLEDGEMENT TO: (Name and Address) | ||||
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3b. INDIVIDUAL'S LAST NAME |
FIRST NAME |
MIDDLE NAME |
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3c. MAILING ADDRESS |
CITY |
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COUNTRY |
Please type or laser-print this form. Be sure it is completely legible. Read all instructions, especially instruction 1; correct Debtor name is crucial. Follow these instructions completely.
Fill in this form very carefully; mistakes may have important legal consequences. If you have questions, consult your legal advisor. The Security Registry cannot give legal advice.
Do not insert anything in the open space in the upper portion of this form; it is reserved for Security Registry use.
When properly completed, send the Security Registry Copy, with required fee, to the Filing Office. Always detach the Debtor and Secured Party Copies.
(A) To assist the Security Reg...