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COLORADO UCC FINANCING STATEMENT <br />Filing Fee: $18 <br />Follow Instrucrions Carefully <br />NAME 8 PHONE OF CONTACT (optional) <br />SEND ACKNOWLEDGMENT T0: (Nart� and Address) <br />� Colorado Water Conservation Board <br />Attn: Water Supply Planning 8� Finance <br />1580 Logan Street, Suite 750 <br />Denver, CO 80203 <br />� ;"�li I_;;;; '. ql ' l: <br />_ _ 1 �.� : .�� <br />� 1;;.iEit <br />°,;�� :�� _ �RY ►1� ��T�TE <br />i:'-�'?-='iifi� i:. <br />�. 1�: �+�: �5 <br />[ <br />� <br />ABOVE SPACE FOR FILI OFFICE USE O NLY <br />t. DEBTOR'S EXACT FULL LEGAL NAME - insert only one deb�or name (1a or 1 b) - do not abbreviate or combine names <br />1 a. ORGANIZATION'S NAME <br />oR HEADGATE 135 LATERAL, INC. <br />1b. INDIVIDUAL'S LAST NAME FIRST NAME <br />1c. MAILINGADDRESS `'" ` <br />3042 BELFORD COURT GRAND JUNCTION <br />ADD'L INFO RE 1e. TYPE OF ORGANIZATION 1i. JURISDICTION OF ORGANIZATION <br />ORGANIZATION D N C CO <br />DEBTOR <br />2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - i�seR onlyQng debtor name (2a or 2b) • do not abbBVia@e or combine names <br />2a. ORGANIZATION'S NAME <br />OR <br />INDIV�DUAL'S LAST NAME <br />2c. MAILJNG ADDRESS <br />INfO RE 12e. TYPE OF ORGANIZATION <br />NAME <br />JURISDICTION OF ORGANIZATION <br />NAME <br />TATE POSTALCODE COUNTRY <br />CO 81504 USA <br />1g. ORGANIZATIONAL IQ�,'rf any <br />C019881086685 pNONE <br />AIDDLE NAME SUFFIX <br />iTATE POSTALCODE COUNTRY <br />ORGANIZATIONAL ID #, i( any <br />� NONE <br />3. SECURED PARTI"S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR SIP) - insert only one secured party name (3a or 3b) <br />3a. ORGANIZATION'S NAME <br />oR State of Colorado - Colorado Water Conservation Board <br />3b. INDIVIDUAL'S LAST NAME FIRST NAME <br />NAME <br />3c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY <br />1580 Logan Street, Suite 750 Denver CO 80203 USA <br />4. This FINANCING STATEMENT covers the folbwing coilateral: <br />SECURED PARTY'S REVENUES PLEDGED TO REPAY LOAN OF $262,600 IN ACCORDANCE <br />WITH LOAN CONTRACT NO. C150270 AND PROMISSORY NOTE, DATED SEPTEMBER 15, 2008. <br />5. ALTERNATIVE OESIGNATION (it appYcabb): ❑ LESSEFJLESSOR ❑ CONSIGNEE/CONSIGNOR ❑ BAILEEIBAILOR ❑ SELLERIBUYER ❑ AG LIEN ❑ NON-UCC FILING <br />6. This FINANCING STATEMENT is to be filed (fw record) in the REAL <br />ESTATE RECORDS <br />8. OPTIONAL fILER REFERENCE DATA <br />Loan Contract No. C150270 <br />NATIONAL UCC FINANCING STATEMENT (FORM UCC1) - COLORADO (REV 71181200� <br />