UNIFORM COMMERCIAL CODE OVERFLOW STANDARD UCC-5/CNS-5 NORTH DAKOTA SECRETARY OF STATE/COUNTY RECORDERS SFN 17831 (09-27-01) THIS FORM INTENDED FOR USE AS AN OVERFLOW SHEET WITH EITHER UCC-1/CNS-1 OR UCC-3/CNS-3 FORMS PLEASE TYPE. Please read directions on back before completing. A. First Debtor Name from UCC-1/CNS-1 or UCC-3/CNS-3: ______________________ B. Debtor's Exact Full Legal Name - do not abbreviate or combine names If individual, Last Name First Individual Organization SSN or TIN 1. __________________________________________________ ____________________________ ADDRESS: _________________________________________________________________________ ADD'L INFO RE ORGANIZATION DEBTOR Individual TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE Organization 2. __________________________________________________ ____________________________ ADDRESS: _________________________________________________________________________ Reserved for Filing Officer Use ADD'L INFO RE ORGANIZATION DEBTOR TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE C. (If filing with UCC-3/CNS-3) This form refers to Original Financial Statement No. _____________________ Date Filed ________________,________. D. SECURED PARTY NAME AND ADDRESS (from which security info is E. ASSIGNEE NAME AND ADDRESS (if any) obtainable) SSN/TIN: Telephone #: SSN/TIN: Telephone #: F. Additional Collateral Description or Other Information: FARM PRODUCTS CENTRAL NOTICE CNS-1 G. List debtor name from CNS-1: This form refers to Original CNS No. H. COUNTY CODE FARM PRODUCT CODE DESCRIPTION (if applicable) CROP YEAR (if applicable) QUANTITY (if applicable) 1. 2. 3. 4. I. Debtor Signature: ______________________________________________ By: ___________________________ By: __________________________ By: ___________________________ By: __________________________ Secured Party Signature: _______________________________________ By: __________________________________________________________ ORIGINAL - Filing Office COPY 1 - Acknowledgement COPY 2 - Filing Party COPY 3 - Filing Party American LegalNet, Inc. www.FormsWorkflow.com UNIFORM COMMERCIAL CODE OVERFLOW STANDARD UCC-5/CNS-5 NORTH DAKOTA SECRETARY OF STATE/COUNTY RECORDERS SFN 17831 (09-27-01) THIS FORM INTENDED FOR USE AS AN OVERFLOW SHEET WITH EITHER UCC-1/CNS-1 OR UCC-3/CNS-3 FORMS PLEASE TYPE. Please read directions on back before completing. A. First Debtor Name from UCC-1/CNS-1 or UCC-3/CNS-3: ______________________ B. Debtor's Exact Full Legal Name - do not abbreviate or combine names If individual, Last Name First Individual Organization SSN or TIN 1. __________________________________________________ ____________________________ ADDRESS: _________________________________________________________________________ ADD'L INFO RE ORGANIZATION DEBTOR Individual TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE Organization 2. __________________________________________________ ____________________________ ADDRESS: _________________________________________________________________________ Reserved for Filing Officer Use ADD'L INFO RE ORGANIZATION DEBTOR TYPE OF ORGANIZATION JURISDICTION OF ORGANIZATION ORGANIZATIONAL ID #, if any NONE C. (If filing with UCC-3/CNS-3) This form refers to Original Financial Statement No. _____________________ Date Filed ________________,________. D. SECURED PARTY NAME AND ADDRESS (from which security info is E. ASSIGNEE NAME AND ADDRESS (if any) obtainable) SSN/TIN: Telephone #: SSN/TIN: Telephone #: F. Additional Collateral Description or Other Information: FARM PRODUCTS CENTRAL NOTICE CNS-1 G. List debtor name from CNS-1: This form refers to Original CNS No. H. COUNTY CODE FARM PRODUCT CODE DESCRIPTION (if applicable) CROP YEAR (if applicable) QUANTITY (if applicable) 1. 2. 3. 4. I. Debtor Signature: ______________________________________________ By: ___________________________ By: __________________________ By: ___________________________ By: __________________________ Secured Party Signature: _______________________________________ By: __________________________________________________________ ORIGINAL - Filing Office COPY 1 - Acknowledgement COPY 2 - Filing Party COPY 3 - Filing Party Acknowledgment Copy American LegalNet, Inc. www.FormsWorkflow.com SFN 17831 (09-27-01) INSTRUCTIONS THIS FORM IS INTENDED FOR USE AS AN OVERFLOW ATTACHMENT WITH EITHER UCC-1/CNS-1 OR UCC-3/CNS-3 FORMS 1. 2. 3. Verify for accuracy and correct spelling. Submit the original and acknowledgment copy to any County Recorder's office or the Secretary of State's office. Refer to the user's guide for further instructions. The guide may be purchased from the Secretary of State's office. A. FIRST DEBTOR NAME FROM UCC-1/CNS-1 OR UCC-3/CNS-3: List the first debtor name from the UCC-1/CNS-1 or UCC-3/CNS-3 this form is attached to for filing. This information will serve as a reference to the form it is accompanying for filing. B. DEBTOR NAME: Individual or Organization - check one per debtor. List up to two (2) additional debtors per overflow form. Follow instructions on UCC-1/CNS-1 form. C. FILING WITH UCC-3/CNS-3: If this form is being filed with a UCC-3/CNS-3, indicate the original financing statement number and date filed indicated on the UCC-3/CNS-3 form, section D. D. SECURED PARTY: Use this section to list an additional secured party. E. ASSIGNEE: Use this section to list an additional assignee. F. ADDITIONAL COLLATERAL DESCRIPTION: Use this space to continue the description of collateral, legal description or other information. G. FIRST DEBTOR NAME FROM CNS-1 PORTION: List first debtor name from the accompanying form. H. FARM PRODUCTS: List additional farm product codes, county codes, etc. I. DEBTOR AND SECURED PARTY SIGNATURE: All additional debtors and secured parties must sign if filing in Central Notice Index. UCC filings do not require signatures. FEES: 1. UCC-5/CNS-5 attachment . . . . . . . . . . . . . . . . . . . . . . $ 1.00 American LegalNet, Inc. www.FormsWorkflow.com