200412064 - Laserfiche WebLink

Browse

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1. DEBTOR'S EXACT FULL LEGAL NAME - insert nnly n e rtehtnr name (1, va . rt„ —1, ohhra.,lolo nr n nhlno la. ORGANIZATION'S NAME OR 2b. INDIVIDUAL'S LAST NAME T 1b. INDIVIDUAL'S LAST NAME ROHRICH M CA a C-) cn o n s n o ROHRICH DONALD o� c n M N N CITY STATE POSTAL CODE COUNTRY P.O. BOX 88 WOOD RIVER f 68883 USA 1d. TAX ID #: SSN OR EIN A 1e. TYPE OF ORGANIZATION UCC FINANCING STATEMENT 1g. ORGANIZATIONAL ID #, if any Q FOLLOW INSTRUCTIONS front and back CAREFULLY -< C) t�D NONE A. NAME & PHONE OF CONTACT AT FILER [optional] O _n (800) 648 -8026 Nora Focht B. SEND ACKNOWLEDGMENT TO: (Name and Address) F &yw I i r DIVERSIFIED FINANCIAL SERVICES, LLC 14010 FIRST NATIONAL BANK PARKWAY SUITE 205 OMAHA, NE 68154 THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1. DEBTOR'S EXACT FULL LEGAL NAME - insert nnly n e rtehtnr name (1, va . rt„ —1, ohhra.,lolo nr n nhlno la. ORGANIZATION'S NAME OR 2b. INDIVIDUAL'S LAST NAME OR 1b. INDIVIDUAL'S LAST NAME ROHRICH INEZ c. L ADDRESS C-) cn o MIDDLE NAME SUFFIX -- - COUNTRY ROHRICH DONALD o� c N CITY STATE POSTAL CODE COUNTRY P.O. BOX 88 WOOD RIVER f 68883 USA 1d. TAX ID #: SSN OR EIN A 1e. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION 1g. ORGANIZATIONAL ID #, if any ORGANIZATION c7) -< C) t�D NONE O _n O r m :3 r— + F—i O O D 07 CD U �-II- z THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1. DEBTOR'S EXACT FULL LEGAL NAME - insert nnly n e rtehtnr name (1, va . rt„ —1, ohhra.,lolo nr n nhlno G. 1 IUIVAL UCD I %JM J rAAU I t-ULL LtI AL NAMt - Insert only one debtor name !2a nr 2h1 - do not ahhrP iata nr r mhi - la. ORGANIZATION'S NAME OR 2b. INDIVIDUAL'S LAST NAME OR 1b. INDIVIDUAL'S LAST NAME ROHRICH INEZ c. L ADDRESS CITY FIRST NAME MIDDLE NAME SUFFIX -- - COUNTRY ROHRICH DONALD NE 1c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY P.O. BOX 88 WOOD RIVER NE 68883 USA 1d. TAX ID #: SSN OR EIN A 1e. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION 1g. ORGANIZATIONAL ID #, if any ORGANIZATION DEBTOR NONE G. 1 IUIVAL UCD I %JM J rAAU I t-ULL LtI AL NAMt - Insert only one debtor name !2a nr 2h1 - do not ahhrP iata nr r mhi - 3. JCL.UMr_U t'/AM I Y -J NAME for NAME of TOTAI ASSIQNFF of ARRI(;N()R .c /P1 - in..H r.nly r,r.o — ...... t ....,.1„ .,—., '- I 2a. ORGANIZATION'S NAME OR 2b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX CITY ROHRICH INEZ c. L ADDRESS CITY STATE — POSTAL CODE -- - COUNTRY P.O. BOX 88 WOOD RIVER NE 68883 USA d. TAX ID #: SSN OR EIN I 'LINFO RE 2e. TYPE OF ORGANIZATION ORGANIZATION DEBTOR -- -- 2f. JURISDICTION OFORGANIZATION 2y. ORGANIZATIONAL ID # deny Jc ;rp 3. JCL.UMr_U t'/AM I Y -J NAME for NAME of TOTAI ASSIQNFF of ARRI(;N()R .c /P1 - in..H r.nly r,r.o — ...... t ....,.1„ .,—., '- I 4. This FINANCING STATEMENT covers the following collateral: 1 -NEW 2004 MODEL 8000 VALLEY PIVOT 1267' o. ALItKNAIIVtUtaIGNAIIUNIifapplicable ]: LESSEElLESSOR CONSIGNEE /CONSIGNOR BAILEE /BAILOR SELLER /BUYER AG. LIEN NON -UCC FILING g, s I Is to e tiled or recor or recor a In the 7, eck to on a for s ESTATE RECORDS. Attach Addendum if a li able ADDITIONAL FEE tional All Debtors Debtor 1 Debtor 2 8. OPTIONAL FILER REFERENCE DATA #0112939 -001 FILING OFFICE COPY— NATIONAL UCC FINANCING STATEMENT (FORM LIM) (REV. 07/29/98) alm 3a. ORGANIZATION'S NAME " OR DIVERSIFIED FINANCIAL SERVICES, LLC 3b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 3c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY 14010 FIRST NAIONAL BANK PARKWAY, 205 OMAHA INE 68154 USA 4. This FINANCING STATEMENT covers the following collateral: 1 -NEW 2004 MODEL 8000 VALLEY PIVOT 1267' o. ALItKNAIIVtUtaIGNAIIUNIifapplicable ]: LESSEElLESSOR CONSIGNEE /CONSIGNOR BAILEE /BAILOR SELLER /BUYER AG. LIEN NON -UCC FILING g, s I Is to e tiled or recor or recor a In the 7, eck to on a for s ESTATE RECORDS. Attach Addendum if a li able ADDITIONAL FEE tional All Debtors Debtor 1 Debtor 2 8. OPTIONAL FILER REFERENCE DATA #0112939 -001 FILING OFFICE COPY— NATIONAL UCC FINANCING STATEMENT (FORM LIM) (REV. 07/29/98) alm