State of Utah DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code UCC Affidavit I, ________________________________________, swear or affirm: 1. I believe that UCC financing statement file number _________________________, which identifies me as debtor, was not authorized and was caused to be communicated to the filing office with the intent to harass or defraud me. 2. My mailing address is: ________________________________________________________________ ________________________________________________________________ City ____________________________ State _________ Zip ______________ I declare under penalty of perjury that the above is true and correct. ________________ _____________________________________ Date Signature STATE OF UTAH COUNTY OF _____________________ Subscribed and sworn to before me on this _______ day of ______________________ 20_____. ________________________________________ Notary Public Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, the business entity physical address may be provided rather than the residential or private address of any individual affiliated with the entity. American LegalNet, Inc. www.FormsWorkFlow.com