County Medical Statement Of Continuation Amendment Etc
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County Medical Statement Of Continuation Amendment Etc Form. This is a Idaho form and can be use in Uniform Commercial Code Secretary Of State.
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Tags: County Medical Statement Of Continuation Amendment Etc, N3, Idaho Secretary Of State, Uniform Commercial Code
Mail to:
Secretary of State
UCC Division
450 N 4th
700 W Jefferson
PO Box 83720
Boise ID 83720-0080
Telephone: 208-334-3191
Fax: 208-334-2847
Instructions:
1.
Please type and sign this form in black.
2.
File only the original. Make copies for your file. The original will be returned as your acknowledgment.
3.
Enter only one debtor’s name or assumed name per debtor block exactly as it is to be indexed.
If more than four names, use an attached sheet. Enter individual debtor names: Last, First
Middle Title; e.g. Smith, John Alan Jr.
4.
Be sure to correctly enter the UCC-1 Financing Statement number assigned by the filing officer.
5.
One or more transactions may be made by a UCC-3. Check the appropriate boxes.
This block for Filing Office use only.
STATE OF IDAHO - COUNTY MEDICAL - STATEMENT
OF CONTINUATION, AMENDMENT, ETC. - FORM N3
Name or business name of each debtor against whom the lien is claimed, and the address of each.
1
First Name
Middle Name
Address
City
State
2
First Name
Middle Name
City
State
First Name
Middle Name
Address
City
State
4
First Name
Middle Name
City
State
Organization or Indiv. Last Name
Organization or Indiv. Last Name
Address
3
Organization or Indiv. Last Name
Organization or Indiv. Last Name
Address
Suffix
Zip
Suffix
Zip
Suffix
Zip
Suffix
Zip
Secured Party or Asignee of Record Name and Address
Organization or Indiv. Last Name
First Name
Middle Name
Address
City
State
Zip
Acknowledgement Name and Address, if not Secured Party
Organization or Indiv. Last Name
First Name
Middle Name
Address
City
State
Zip
New Asignee Name and Address
Organization or Indiv. Last Name
First Name
Middle Name
Address
City
State
Amendment or release information:
This statement refers to UCC-1 financing statement file Filed on: (month/day/year)
number:
Zip
CONTINUATION. The original financing statement bearing file number
shown above is still effective.
TERMINATION. Secured party no longer claims a security interest
under the financing statement bearing file number shown above.
ASSIGNMENT. The secured party’s right under the financing
statement bearing file number shown above has been assigned to the
assignee shown below.
AMENDMENT. Financing statement bearing file number shown above
is amended as set forth below.
RELEASE. Secured party releases the collateral described below from
the financing statement bearing the file number shown above.
Signature of Secured Party or Assignee of Record:
Rev. 07/2001
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