State of Mississippi UCC-11
Financing Statement
*UCC-11-* Copy Request. Filing Officer please furnish exact copies of all Financing Statements and Statements of Assignment, which are on file with your office. Enclosed is the statutory fee. Upon receipt of these copies, the undersigned agrees to pay to the Filing Officer the fee for each page of each Financing Statement and each Statement of Assignment reported on the certificate. Information Request. Filing Officer please furnish certificate showing there is on file any presently effective statement, or any statement of assignment of each party named therein. Enclosed is the statutory fee. The undersigned party further agrees to pay to the filing officer upon receipt of the above certificate, the fee for each financing statement and each statement of assignment reported on the certificate Signatures of Requesting Party File No. Date and Hour of Filing Name and Address of Secured Party
Office Use Only The undersigned Filing Officer hereby certifies that the attached copies are true and exact copies of all available Financing Statements or Statements of Assignment filed in this office. Dated this day of ,A.D. Signature of Filing Officer The undersigned Filing Officer hereby certifies that the attached/listed information is a record of all presently effective Financing Statements or Statements of Assignment that name the above Debtor and which are on file in my office as of at M. $ Signature of Filing Officer Additional Fee Required UCC-11 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 Tax ID/SSN Tax ID/SSN State ZIP Cty Cd 2. Requesting Party Phone: ( ) -