REQUEST FOR INFORMATION - California Department of ...



STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATIONEXHIBITREQUEST FOR INFORMATION - FORM UCC38-EX-21 (9/97)(Form #)Page 1 of 2STATE OF CALIFORNIASECRETARY OF STATEUNIFORM COMMERCIAL CODE DIVISIONREQUEST FOR INFORMATION - FORM UCC3Filing Officer please provide the following type(s) of information concerning the debtor named below:(For personal name, show LAST NAME, FIRST NAME)DEBTOR NAME:SSN/FTN: (optional)ADDRESS:CITY:STATE:ZIP:COUNTRY:** PLEASE CHECK AT LEAST ONE REQUEST TYPE BELOW **______ CERTIFICATEA list of active filings containing the information stated above.______ COPIESIf copies are requested at the same time as a CERTIFICATE, copies of all filings appearing on the CERTIFICATE will be provided, unless otherwise noted.If only copies are requested, up to 10 file numbers may be listed below. Copies are not certified unless requested. An additional fee is required in that case.Special Instructions:(This section applies if only COPIES are requested)FILE NUMBERTYPE OF DOCUMENT FILE DATEQUANTITY/INSTRUCTIONS This Space Reserved for Useby the Filing OfficerSIGNATURE OF REQUESTOR:Date:RETURN INFORMATION TO NAME:ADDRESS:CITY:STATE:ZIP:COUNTRY:INSTRUCTIONS FOR COMPLETINGEXHIBITREQUEST FOR INFORMATION - FORM UCC38-EX-21 (New 9/97)(Form #)Page 2 of 21.Please type or print clearly when completing this form.2.Please show the name and address of the debtor for whom the information is requested.a.Only one (1) debtor name per UCC3 will be accepted. Please show the debtor name exactly as it should appear in our records. If a personal name is requested, type or print the LAST NAME first.b.Please show only (1) debtor address. “Any Address” may be stated rather than a specific address.c.A social security number (SSN) and/or federal tax number (FTN) is optional. If stated, it will be used to further identify the debtor in our records.PLEASE NOTE: If you want a very broad search of our records, do not show an SSN/FTN or a specific address for the debtor.3.Please check the appropriate type of information requested. At least one type must be marked.4.The signature of the requesting party is required.5.The RETURN INFORMATION TO section of the UCC3 form must be completed and legible.6.Please send the original and one copy to the Filing Officer. The original will be retained by the Filing Office and the copy returned with the requested information. ................
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