State of Mississippi UCC-1 Financing Statement UCC-01 Filed with: Book & Page: 1. Debtors (Last Name first for individuals) Last Name First Name Middle Name Last Name First Name Middle Name Mailing Address Mailing Address State ZIP City Cty Cd City Transmitting Utility Tax ID/SSN Tax ID/SSN 2. Secured Party (Last Name first for individuals) 3. Assignee (Last Name first for individuals) Business Name Business Name Mailing Address Mailing Address 4. This financing statement covers the following types (or items) of property: 5. Check if this statement is filed without the Debtor's signature to perfect a security interest in collateral Office Use Only already subject to a security interest in another jurisdiction when it was brought into this state or when Debtor's location was changed to this state which is proceeds if the security interest in the original collateral was where the original filing has lapsed perfected acquired after a change of name, identity, or corporate structure of the if lien to secure payment of royalty proceeds Debtor (effective 1 year) Products of Collateral 6. Check if covered: 7. Number of additional sheets attached: Signature of Debtor Signature of Secured Party Signature of Debtor Signature of Secured Party (Required only when filed without Debtor Signature) *ucc-01-0-?? State ZIP Cty Cd State ZIP City Cty Cd City Tax ID/SSN Tax ID/SSN State ZIP Cty Cd