Idaho > Secretary Of State > Uniform Commercial Code

County Medical N1 - Idaho

County Medical Form. This is a Idaho form and can be used in Uniform Commercial Code Secretary Of State .
 Fillable pdf Last Modified 12/9/2008
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STATE OF IDAHO - COUNTY MEDICAL - FORM N1 Mail to: Secretary of State UCC Division Telephone: 208-334-3191 700 W Jefferson PO Box 83720 Fax: 208-334-2847 Boise ID 83720-0080 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 debtors name or assumed name per debtor block exactly as it is to be indexed. If more than four names, use an attached sheet. 4. When the obligation has been satisfied, complete the Termination Statement andThis block for Filing Office use only. return the original to the filing officer. Name or business name of each debtor against whom the lien is claimed, and the address of each. Organization or Indiv. Last Name First Name Middle Name Suffix1 Address City State Zip Organization or Indiv. Last Name First Name Middle Name Suffix2 Address City State Zip Organization or Indiv. Last Name First Name Middle Name Suffix3 Address City State Zip Organization or Indiv. Last Name First Name Middle Name Suffix4 Address City State Zip Secured Party Name and Address Organization or Indiv. Last Name First Name Middle Name Address City State Zip Assignee Name and Address Organization or Indiv. Last Name First Name Middle Name Address City State Zip Acknowledgment Name and Address, if not Secured Party Organization or Indiv. Last Name First Name Middle Name Address City State Zip This financing statement covers the following types or items of property: Signature of Secured Party: TERMINATION STATEMENT The Secured Party no longer claims a security interest under the financing statement. Signature of Secured Party / Assignee of Record Date Rev. 07/2001
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