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Information Sheet and Fees Required

for Filing UCC-1 Financing Statement

List of required Documents:

This Application (please print this form)

Copy of Birth Certificate (both sides)

Other Birth Documents

Copy of Drivers License

Copy of Both Sides of Social Security Cards(s)

Copy of Passport I.D. Page

Copy of UCC Financing Statement (if applicable)

Corporation or Business Information (see below)

Fee for Identity Redemption document preparation and education

service (payment due with this information sheet)  $1,997.00

Notes: You are responsible for all State and County filing fees.

              We only accept Cash, or Money Orders.

Mailing Address:

Application

Your full name: _______________________________________ Telephone: ________________

Your mailing location:

Street Address_________________________________

City_________________________________________

State________________Zip________County____________

e-mail address: _______________________________________________________________     

Social Security #:     ________________________________ 

Birth Certificate #:    ___________________________State __________ Birth Date ___________

Date of your 18th Birthday_____________________

Passport # _______________________________________________ Country ________________

Driver License #       ______________________________ State __________________

AKA's                      _____________________________________________

                             _____________________________________________

Your Maiden Name: __________________Other married name(s): __________________________

Have you already filed a UCC-1?  YES  NO (circle one) Security Agreement? YES NO (circle one)

First UCC-1 filing #    __________________ date filed ______________ State_______________

Second UCC-1 filing #__________________ date filed ______________ State ______________

Treasury Direct Account #________________________ Posted Treasury Registered Account # _________

       Fill out all information completely. All information is required, Street Address,

       Zip, etc. If you do not have a requested item or number, or cannot get that

       information, state in blank, DO NOT HAVE, or CANNOT GET, or other explanation.

ADDITIONAL INFORMATION REQUIRED

IF YOU PARTICIPATE IN AN ENTITY (i.e. Corporation, L.L.C.)

If you have provided services and have agreed to be a "responsible party" for legal fictions, such as trusts, partnerships, firms, or corporations, (ENTITIES) you have the right to protect yourself from potential liability coming from the public side.  You can do that through this registration.  If you are not participating in ENTITIES you do not need to send in this portion of the form. If you are it is a good thing to do, so you will have this information included in the collateral list.

1. Name of Entity _____________________________ [EX:  ABC Investments, Inc.]     

Address ______________________________________________________________

Is it a corporation or LLC? :_____________________________________________________

County Clerk Record File Number ___________________, Liber _________ Page _________                       

Title              [EX:  Trustee] _______________________________________

Date of acceptance of appointment:___________________________________

Name of Creator____________________________________________________

State were created _____________