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COLORADO UCC FINANCING STATEMENT <br />Filing Fee: $15 <br />Follow Instructions (front and back) Carefully <br />NAME & PHONE OF CONTACT (optional) <br />SEND ACKNOWLEDGMENT TO: (Name and Address) <br />( COLORADO WATER CONSERVATION <br />BOARD <br />ATTN: WATER SUPPLY PLANNING & <br />FINANCE <br />1580 LOGAN STREET, SUITE 750 <br />DENVER, COLOARDO 80203 <br />c8. <br />i = 00 <br />OF STATE <br />10 _02- 006 <br />ABOVE SPACE FOR FILING OFFICE USE ONLY <br />1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (1 a or 1b) - do not abbreviate or combine names <br />1a. ORGANIZATION'S NAME <br />OR <br />11b. INDIVIDUAL'S LAST NAME FIRST NAME <br />CARROLL Caryl <br />1c. MAILING ADDRESS CITY <br />PO BOX 219 COCA <br />ADD'L INFO RE 1e. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION <br />ORGANIZATION <br />2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (2a or 2b) - do not abbreviate or combine names <br />2a. ORGANIZATION'S NAME <br />OR <br />INDIVIDUAL'S LAST NAME <br />2c, MAILING ADDRESS <br />INFO RE I2e. TYPE OF ORGANIZATION <br />NIZATION <br />FIRST NAME <br />JURISDICTION OF ORGANIZATION <br />MIDDLE NAME <br />6urrix <br />R. <br />STATE <br />POSTAL CODE <br />COUNTRY <br />FL <br />32923 -0219 <br />USA <br />1g. ORGANIZATIONAL ID#, if any <br />NONE <br />MIDDLE NAME <br />ISUFFIX <br />TE I POSTAL CODE <br />3, SECURED PARTY'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 COLORADO WATER CONSERVATION BOARD <br />3b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME <br />ORGANIZATIONAL ID #, if any <br />NONE <br />LINGADDRESS CITY STATE POSTAL CODE COUNTRY <br />3c.MAI <br />1580 LOGAN STREET, SUITE 750 DENVER CO 80203 USA <br />4. This FINANCING STATEMENT covers the following collateral: <br />SECURED PARTY'S REVENUES PLEDGED TO REPAY LOAN OF $50,000.00 IN ACCORDANCE <br />WITH LOAN CONTRACT NO. C153682 AND PROMISSORY NOTE DATED AUGUST 22, 1994. <br />5. ALTERNATIVE DESIGNATION (if applicable): O LESSEE /LESSOR E3 CONSIGNEE/CONSIGNOR 13 BAILEEIBAILOR [3 SELLER/BUYER 13 AG LIEN [3 NON-UCC FILING <br />filed or record In the L 7. Check to REQUEST SEARCH REPORT(S) on Debtor(s) (Optional) <br />is NA IN A M N is to be Debtor 2 <br />1­1 All Debtors E] Debtor 1 <br />8. OPTIONAL FILER REFERENCE DA I A <br />LOAN CONTRACT NO. C153682 <br />NATIONAL UCC FINANCING STATEMENT (FORM UCC1) - COLORADO (REV 11/1512001) <br />