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This FINANCING STATEMENT Is presented for filing and will remain effective, with certain exceptions, for five years from the date of filing, pursuant to Section 9403 of the California Uniform Commercial Code. 1. DEBTOR (LAST NAME FIRST- IFAN INDIVIDUAL) A. SOCIAL SECURITY OR FEDERALTAX NO. Johnson, Carol 363-54-7911 19, MAILING ADDRESS 1 C. CITY. STATE ID. ZIP CODE 388 Pleasant Way San Leandro, CA 94577 2. ADDITIONAL DEBTOR (IF ANY) (LAST NAME FIRST - IF AN INDIVIDUAL 2A. SOCIAL SECURITY OR FEDERAL TAXNO. N.A. 2B. MAILING ADDRESS 2C. CITY. STATE - 2D. ZIPCODE 3. DEBTOR'S TRADE NAMES OR STYLES (IF ANY) 3A. FEOERALTAX NUMBER C.J. Hair Pending 4. SECUREDPARTY 4A. SOCIAL SECURITY NO.. FEDERAL TAX NO. OR BANK TRANSIT AND A.B.A. NO. NAME ' MAILING ADDRESS CITY STATE ZIP CODE 5. ASSIGNEE OF SECURED PARTY (IF ANY)'"'� OR BANK TRANSIT AND A.B.A. NO - NAME MAILING ADDRESS CITY STATE ZIP CODE 6. This FINANCING STATEMENT covers the following types or items of property (include description of real property on which located and owner of record when required by instruction 4). See attached sheet. 78. DEBTORS) SIGNATURE NOT REQUIRED IN ACCORDANCt VVI I M ( 7. CHECK. Z 1 7A. PRODUCTS OF COLLATERAL INSTRUCTION 5(A) ITEM: IF APPLICABLE ElARE ALSO COVERED (1 ) ❑ (2) 1 3) (4 ) I — 8. CHECK I IF APPLICABLE ❑ DEBTOR IS A "TRANSMITTING UTILITY" IN ACCORDANCE WITH UCC § 9105 (1) (NI I 9. 10. SIGNATURE(S) OF DEB RISI Carol Johnson TYPE OR PRINT NAME(S) OF DEBTOR(W ^^ SECURED PARTY(IESI DATE: _ N 10. THIS SPACE FOR USE OF FILING OFFICER (DATE. TIME. FILE NUMBER AND FILING OFFICER) John Jermanis, Fianance Director, City of San Leandro TYPE OR PRINT NAMES) OF SECURED PARTY(IES) 1 1 . Return copy to: NAME F— Development Services Department ADDRESS City of San Leandro CITY 835 East l4th Street STATE I San Leandro, CA 94577 ZIP CODE L FORM UCC.1 01 FILING OFFICER COPY Approved by the Secretary of State 1 2 3 4 5 6 7 8 9 0 REDI F ORM . 5S801/5P801 POLYPAK (50 SETS)