Ind. Code § 26-1-9.1-521 – Uniform form of written financing statement and amendment

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 IC 26-1-9.1-516 (b) or IC 26-1-9.1-901 :

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 a 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
	☐ Consignee/Consignor ☐ Seller/Buyer ☐ Bailee/Bailor ☐ Licensee/Licensor
8.	OPTIONAL FILER REFERENCE DATA
	________________________________________________________________________________________
	[UCC FINANCING STATEMENT (Form UCC1)]
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
	__________________________________________________________________________________
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)]
	(b) 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 described in IC 26-1-9.1-516(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 UCC3Ad) 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
	__________________________________
	ADDITIONAL NAME(S)/INITIAL(S)					SUFFIX
	______________________________________					_________
10.	OPTIONAL FILER REFERENCE DATA
	___________________________________________________________________
	[UCC FINANCING STATEMENT AMENDMENT (Form UCC3)]
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 UCC3Ad)]".

As added by P.L.57-2000, SEC.45. Amended by P.L.1-2007, SEC.182; P.L.54-2011, SEC.18; P.L.86-2013, SEC.2.