WA Rev Code § 62A.9A-521 (2021)
2021 Revised Code of Washington|Title 62A - Uniform Commercial Code|Chapter 62A.9A - Secured Transactions; Sales of Accounts, Contract Rights and Chattel Paper.|62A.9A-521 - Uniform form of written financing statement and amendment.

RCW 62A.9A-521 Uniform form of written financing statement and amendment.(a) Initial financing statement form. A filing office that accepts written records may not refuse to accept a written initial financing statement in the following form and format except for a reason set forth in RCW 62A.9A-516(b):UCC FINANCING STATEMENTFOLLOW INSTRUCTIONS         A.NAME & PHONE OF CONTACT AT FILER (optional)                  B.EMAIL CONTACT AT FILER (optional)                  C.SEND ACKNOWLEDGMENT TO: (Name and Address)                  THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY1.DEBTOR'S NAME - provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name) 1a.ORGANIZATION'S NAMEOR  1b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX          1c.MAILING ADDRESSCITYSTATEPOSTAL CODECOUNTRY2.DEBTOR'S NAME - provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name) 2a.ORGANIZATION'S NAMEOR  2b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX          2c.MAILING ADDRESSCITYSTATEPOSTAL CODECOUNTRY3.SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY) - provide only one secured party name (3a or 3b) 3a.ORGANIZATION'S NAMEOR  3b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S)SUFFIX          3c.MAILING ADDRESSCITYSTATEPOSTAL CODECOUNTRY4.COLLATERAL: This Financing Statement covers the following collateral:                  5.Check only if applicable and check only one box:Collateral is□ held in Trust (see Instructions)   □ being administered by a Decedent's Personal Representative.  6a.Check only if applicable and check only one box: □ Public-Finance Transaction□ Manufactured-Home Transaction□ A Debtor is a Transmitting Utility6b.Check only if applicable and check only one box:  □ Agricultural Lien□ Non-UCC Filing 7.ALTERNATIVE DESIGNATION (if applicable):    □ Lessee/Lessor□ Cosignee/Cosignor□ Seller/Buyer□ Bailee/Bailor□ Licensee/Licensor8.OPTIONAL FILER REFERENCE DATA[UCC FINANCING STATEMENT (FORM UCC1)] (REV. 09/30/10)UCC FINANCING STATEMENT ADDENDUMFOLLOW INSTRUCTIONS9.NAME OF FIRST DEBTOR (same as item 1a or 1b on Financing Statement) 9a.ORGANIZATION'S NAMEOR  9b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S)SUFFIXTHE ABOVE SPACE IS FOR FILING OFFICE USE ONLY10.ADDITIONAL DEBTOR'S NAME - provide only one Debtor name (10a or 10b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name) 10a.ORGANIZATION'S NAME (exact, full name, without any modifications)OR  10b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX          10c.MAILING ADDRESSCITYSTATEPOSTAL CODECOUNTRY11.□ ADDITIONAL SECURED PARTY'S NAME or □ ASSIGNOR SECURED PARTY'S NAME - provide only one name (11a or 11b) 11a.ORGANIZATION'S NAMEOR  11b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S)SUFFIX          11c.MAILING ADDRESSCITYSTATEPOSTAL CODECOUNTRY12.ADDITIONAL SPACE FOR ITEM 4 (Collateral)   13.□ This FINANCING STATEMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS (if applicable) 14.This FINANCING STATEMENT:  □ covers timber to be cut□ covers as-extracted collateral□ is filed as a fixture filing15.Name and address of a RECORD OWNER of real estate described in item 16 (if Debtor does not have a record interest)16.Description of real estate17.Miscellaneous[UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad)] (REV. 09/30/10)(b) Amendment form. A filing office that accepts written records may not refuse to accept a written record in the following form and format except for a reason set forth in RCW 62A.9A-516(b):UCC FINANCING STATEMENT AMENDMENTFOLLOW INSTRUCTIONS         A.NAME & PHONE OF CONTACT AT FILER (optional)                  B.EMAIL CONTACT AT FILER (optional)                  C.SEND ACKNOWLEDGMENT TO: (Name and Address)                  THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY1a.INITIAL FINANCING STATEMENT FILE NUMBER 1b.This FINANCING STATEMENT AMENDMENT is to be filed (for record) (or recorded) in the REAL ESTATE RECORDS. Filer: attach Amendment Addendum (Form UCC3 Ad) and provide Debtor's name in item 13.2.□ TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to the security interest(s) of Secured Party authorizing this Termination Statement.3.□ ASSIGNMENT (full or partial): Provide name of Assignee in item 7a or 7b, and address of Assignee in item 7c and name of Assignor in item 9. For partial assignment, complete items 7 and 9 and also indicate affected collateral in item 8.4.□ CONTINUATION: Effectiveness of the Financing Statement identified above with respect to the security interest(s) of Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law.5.□ PARTY INFORMATION CHANGE:Check one of these two boxes:This Change affects □ Debtor or □ Secured Party of record AND Check one of these three boxes to:  □ CHANGE name and/or address: Complete item 6a or 6b; and item 7a or 7b and item 7c. □ ADD name: Complete item 7a or 7b, and item 7c. □ DELETE name: Give record name to be deleted in item 6a or 6b.6.CURRENT RECORD INFORMATION: Complete for Party Information Change - provide only one name (6a or 6b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name) 6a.ORGANIZATION'S NAMEOR  6b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S)SUFFIX7.CHANGED OR ADDED INFORMATION: Complete for Assignment or Party Information Change - provide only one name (7a or 7b) (use exact full name; do not omit, modify, or abbreviate any word in the Debtor's name) 7a.ORGANIZATION'S NAMEOR  7b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S) THAT ARE PART OF THE NAME OF THIS DEBTORSUFFIX          7c.MAILING ADDRESSCITYSTATEPOSTAL CODECOUNTRY8.□ COLLATERAL CHANGE:Also check one of these four boxes: □ ADD collateral□ DELETE collateral□ RESTATE covered collateral□ ASSIGN collateral Indicate collateral:   9.NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT - provide only one name (9a or 9b) (name of assignor, if this is an Assignment).If this is an Amendment authorized by a DEBTOR, check here □ and provide name of authorizing Debtor 9a.ORGANIZATION'S NAMEOR  9b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S)SUFFIX10.OPTIONAL FILER REFERENCE DATA[UCC FINANCING STATEMENT AMENDMENT (FORM UCC3)] (REV. 09/30/10)UCC FINANCING STATEMENT AMENDMENT ADDENDUMFOLLOW INSTRUCTIONS11.INITIAL FINANCING STATEMENT FILE NUMBER (same as item 1a on Amendment form)12.NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on Amendment form) 12a.ORGANIZATION'S NAMEOR  12b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S)SUFFIXTHE ABOVE SPACE IS FOR FILING OFFICE USE ONLY13.Name of DEBTOR on related financing statement (Name of a current Debtor of record required for indexing purposes only in some filing offices - see Instruction for item 13 - insert only one Debtor name (13a or 13b) (use exact, full name; do not omit, modify, or abbreviate any word in the Debtor's name) 13a.ORGANIZATION'S NAMEOR  13b.INDIVIDUAL'S SURNAMEFIRST PERSONAL NAMEADDITIONAL NAME(S)/INITIAL(S)SUFFIX14.ADDITIONAL SPACE FOR ITEM 8 (Collateral)   15.This FINANCING STATEMENT AMENDMENT:  □ covers timber to be cut□ covers as-extracted collateral□ is filed as a fixture filing16.Name and address of a RECORD OWNER of real estate described in item 17 (if Debtor does not have a record interest)17.Description of real estate18.MISCELLANEOUS: UCC FINANCING STATEMENT AMENDMENT ADDENDUM (FORM UCC1) (REV. 09/30/10)[ 2011 c 74 § 406; 2000 c 250 § 9A-521.]NOTES:Application--Effective date--2011 c 74: See notes following RCW 62A.9A-102.