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FOLLOW INSTRUCTIONS (front and back) CAREFULLY A. NAME & PHONE OF CONTACT AT FILER [optional] B. SEND ACKNOWLEDGEMENT TO: (Name and Address)
John Henry Doe c/o 1234 Creditor Street Huntington Beach, California Republic NON-DOMESTIC WITHOUT THE U.S. ZZZ
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1. DEBTORS EXACT FULL LEGAL NAME insert only one debtor name (1a or 1b) do not abbreviate or combine names
1a. ORGANIZATIONS NAME OR
Reset
PETER F DOE
1b. INDIVIDUALS LAST NAME FIRST NAME MIDDLE NAME SUFFIX
CITY
STATE
POSTAL CODE
COUNTRY
HUNTINGTON BEACH
1f. JURISDICTION OF ORGANIZATION
CA
92648
USA
NONE
LEGAL ENTITY
USA
***-**-1234
2. ADDITIONAL DEBTORS EXACT FULL LEGAL NAME insert only one debtor name (2a or 2b) do not abbreviate or combine names
2a. ORGANIZATIONS NAME OR
JOHN H DOE
2b. INDIVIDUALS LAST NAME FIRST NAME MIDDLE NAME SUFFIX
CITY
STATE
POSTAL CODE
COUNTRY
HUNTINGTON BEACH
2f. JURISDICTION OF ORGANIZATION
CA
92648
***-**-6789
USA
NONE
LEGAL ENTITY
USA
3. SECURED PARTYS NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) insert only one secured party name (3a or 3b)
3a. ORGANIZATIONS NAME OR 3b. INDIVIDUALS LAST NAME FIRST NAME MIDDLE NAME SUFFIX
Doe
3c. MAILING ADDRESS
John
CITY
Henry
STATE POSTAL CODE COUNTRY
ZZZ
THIS IS ACTUAL AND CONSTRUCTIVE NOTICE All the Debtors' interest in the Case/Account No. 2:10-CR-01234-JMM-SS, being held by in the United States District Court for the Central District of California, Western Division, is hereby Accepted as collateral for securing contractual obligations in favor of the Secured Party. The value of the Secured Party's claim is Fifty-five Million and 00/100 United States Dollars (USD $55,000,000.00). This is the entry of the DEBTORS into the Commercial Registry and Public Notice of a commercial transaction. The Secured Party hereby secures all rights, interests and titles in said property. VALUE: $55,000,000.00
LESSEE/LESSOR
CONSIGNEE/CONSIGNOR
BAILEE/BAILOR
SELLER/BUYER
AG. LIEN
This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL ESTATE RECORDS. Attach Addendum [if applicable] 8. OPTIONAL FILER REFERENCE DATA
All Debtors
PETER F DOE
OR
9b. INDIVIDUALS LAST NAME FIRST NAME MIDDLE NAME, SUFFIX
10. MISCELLANEOUS:
11. ADDITIONAL DEBTORS EXACT FULL LEGAL NAME insert only one name (11a or 11b) do not abbreviate or combine names
11a. ORGANIZATIONS NAME OR
FRANK J DOE
11b. INDIVIDUALS LAST NAME FIRST NAME MIDDLE NAME SUFFIX
CITY
STATE
POSTAL CODE
COUNTRY
HUNTINGTON BEACH
11f. JURISDICTION OF ORGANIZATION
CA
92646
***-**-2345
USA
NONE
LEGAL ENTITY
USA
12.
CITY
STATE
POSTAL CODE
COUNTRY
13. This FINANCING STATEMENT covers collateral, or is filed as a 14. Description of real estate: fixture filing.
timber to be cut or
as-extracted
15. Name and address of a RECORD OWNER of above-described real estate (if Debtor does not have a record interest):
17. Check only if applicable and check only one box. Debtor is a Trust or Trustee acting with respect to property held in trust or Decedents Estate
18. Check only if applicable and check only one box. Debtor is a TRANSMITTING UTILITY Filed in connection with a Manufactured-Home Transaction effective 30 years Filed in connection with a Public-Finance Transaction effective 30 years
FILING OFFICE COPY NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) CALIFORNIA (REV. 01/01/08)