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Sample Uniform Commercial Code 1 Financing Statement
1. Name of Debtor: ______________________________________________________________
Address of Debtor: ______________________________________________________________
2. Name of Secured Party: _________________________________________________________
Address of Secured Party: __________________________________________________________
3. This Financing Statement covers the following types (or items) of property:
4. Check here ___ if collateral is crops. The above described crops are growing or are
to be grown on (Describe real estate): __________________________________________.
5. (Check here ___ if collateral is goods which are or are to become fixtures, timber to
cut, or minerals or the like (including oil and gas) or accounts to be financed at the
wellhead or minehead of the well or mine). The legal description of the real estate is:
Financing Statement is to be filed in the office where a mortgage on the real estate
would be recorded. If the debtor does not have an interest of record, the name of the
record owner is: ___________________________________________.
6. Proceeds and products of collateral are also covered.
Signature of Secured Party
Signature of Debtor