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UCC FINANCING STATEMENT AMENDMENT <br />Filing Fee: $18 <br />Follow Instructions Carefully <br />NAME & PHONE OF CONTACT (optional) <br />SEND ACKNOWLEDGMENT TO: (Name and Address) <br />1 Colorado Water Conservation Board <br />Finance Section <br />1580 Logan Street, Suite 600 <br />Denver, CO 80203 <br />;._– "# <br />ABOVE SPACE FOR FILING OFFICE USE ONLY <br />1. Initial Financing Statement Information (Required) <br />1a. Original Filing Number: 20062095842 C 1b. Original Filing Date: 10-02-061 1c. If filed prior to January 1, 2000, indicate Original Filing Office: <br />. ❑ Term l nation: Effectiveness of the Financing Statement identified above is terminated with respect to security interest(s) of the Secured Parry authorizing this Termination Statement. <br />3. on inua ion: Effectiveness of the Financing Statement identified above with respect to security interest(s) of the Secured Party authorizing this Continuation Statement <br />is continued for the additional period provided by applicable law. <br />4. ❑ ssignment: Give name of assignee in item 7a or 7b and address of assignee in item 7c; also give name of assignor in item 9. <br />5. Amendment a n orma Ion : This Amendment affects Debtor or Secured Party of record. Check only one of these two boxes. <br />Also check one of the following three boxes and provide appropriate information in items 6 and/or 7. <br />❑ CHANGE name and/or address: Give current record name in item 6a or 6b; also give ❑ DELETE name: Give record name ❑ ADD name: Complete item 7a or 71b, and also <br />new name If name change) in item 7a or 71b and/or new address R address change) in item 7c. to be deleted in 6a or 61b. item 7c; also complete items 7e -7g (if applicable) <br />6. CURRENT RECORD INFORMATION: <br />OR <br />6a. ORGANIZATION'S NAME <br />6b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME <br />CARROLL I CARYL I R. <br />7. CHANGED (NEW) OR ADDED INFORMATION: <br />OR <br />7a. ORGANIZATION'S NAME <br />7b. INDIVIDUAL'S LAST NAME IFIRST NAME IMIDDLE NAME <br />7c. MAILING ADDRESS CITY STATE POSTAL CODE ICOUNTRY <br />P.O. BOX 561498 ROCKLEDGE FL 32956 1 USA <br />ADD'L INFO RE 7e. TYPE OF ORGANIZATION 7f. JURISDICTION OF ORGANIZATION 7g. ORGANIZATION ID#, if any <br />ORGANIZATION <br />1ENDMENT (COLLATERAL CHANGE): check only one box. <br />Describe collateral ❑deleted or ❑added, or give entire ❑restated collateral description, or describe collateral ❑assigned <br />SECURED PARTY'S REVENUES PLEDGED TO REPAY LOAN OF $75,000.00 IN ACCORDANCE <br />WITH LOAN CONTRACT NO. C153682, AS AMENDED, AND PROMISSORY NOTE, DATED <br />DECEMBER 6, 1995. <br />9. NAME OF SECURED PAR I Y OF RECORD AUTHORIZING THIS AMENDMENT (name of assignor, if this is an Assignment). If this is an Amendment authorized by t <br />Debtor which adds collateral or adds the authorizing Debtor, or if this is a Termination authorized by a Debtor, check here [—]and enter name of DEBTOR authorizing this Amendmen <br />19a. ORGANIZATION'S NAME <br />OR State of Colorado - Colorado Water Conservation Board <br />INDIVIDUAL'S LAST NAME <br />10. OPTIONAL FILER REFERENCE DATA <br />Loan Contract No. C153682 <br />NAME IMIDDLE NAME ISUFFIX <br />NATIONAL UCC FINANCING STATEMENT AMENDMENT (FORM UCC3) - COLORADO (REV 7118/2007) <br />NONE <br />