Instructions for completing the UCC-11R Request For Certificate Of Information Please type or print form information. Read all instructions. Follow instructions completely. Complete form clearly. Be sure to enclose the proper fee amount. A separate UCC-11R form and fee must be submitted for each debtor name. Box Numbers Item Instructions 1. For Office Use Only Do not write in this box. This is for Filing Officer use only. 2. Requesting Party Type or print the name and address of the party requesting UCC information. To assist filing officers who might wish to communicate with the requester, please include a contact person's name and daytime phone number. 3. Debtor Enter the legal name and mailing address of the debtor. Check the PERSONAL or BUSINESS box to identify the debtor type. A search fee is required for each debtor name or name variation you would like searched. Husband and wife are considered individual debtors and require separate search requests and fee. Trade names, DBAs, AKAs, or FKAs are also considered separate identities. Each name requires its own request and fee. Boxes for city and county address information will reflect all addresses in either the City or County named on your request. Check the ALL box to request a search of all addresses on file under the debtor's name. 4. Type of Certificate of Information you are requesting Check one box to request certificate of information. The certification of information type that you request, will determine the fee amount. 5. Type of Search you are requesting Check one box to request search type. List all relevant filing numbers on the form when you are requesting copies of specific files. 6. Mailing Address Mail request forms to: Uniform Commercial Code Department of Licensing PO Box 9660 Olympia WA 98507-9660 Make checks payable to the Department of Licensing Private carrier address: 405 Black Lake Boulevard, First Floor, Olympia WA 98502 UCC11R Req. for Cert. of Info. (R/2/00)M/W Page 1 of 2 The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, please call (360)6641530 or TDD (360)586-2788. 2000 © American LegalNet, Inc. 1. FOR OFFICE USE ONLY Request for Certificate of Information 2. Requesting Party Information RETURN SEARCH TO: (name and address) Contact: _______________________________ Phone No. ( 3. Debtor Name ) (List one debtor per request) Personal Name: Business Address: Street/Route City State Zip (Please use the boxes below to request additional debtor addresses) All addresses in the city of All addresses in the county of All addresses 4. Type of Information Requested (Check one box only) Certificate of Information* (named above, for address shown in box #1) Certificate of Information* and true and exact copies *Certificate of information contains file number, file date, secured party name and address. 5. Type of Search (Check one box only) All Current UCC filings and liens for the debtor Any Current UCC filings and liens dated from to Notice of Federal tax liens only Only the specific filing numbers listed: 6. PLEASE FORWARD ALL INFORMATION TO: Uniform Commercial Code Department of Licensing PO Box 9660 Olympia WA 98507-9660 (360) 664-1530 MAKE CHECKS PAYABLE TO: Department of Licensing The Department of Licensing hereby disclaims responsibility in this record search and certification for other than the specifically named debtor at the exact address(es) cited in your request. Searching a variation of the debtor name or additional names requires separate request forms and fees. UCC11R Req. for Cert. of Info. (R/2/00) Page 2 of 2 2000 © American LegalNet, Inc.