Effective Financing Statement (EFS)

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1 Fax For Office Use Only Effective Financing Statement (EFS) 1. Contact and Send Acknowledgment To: a. Name and Phone of Contact at Filer (optional) b. PAD Account # to be Charged c. Send Acknowledgement To: (Name and Address) d. Contact at Filer (optional) 2. Debtor s Exact Full Legal Name (only one (1) debtor name (2a or 2b): c. Mailing Address City State Postal 3. Debtor s Exact Full Legal Name (only one (1) debtor name (3a or 3b): c. Mailing Address City State Postal 4. Secured Party s or Assignee s Exact Full Legal Name (only one (1) secured party name (4a or 4b): Check if Assignee c. Mailing Address City State Postal d. Secured Party s Signature, Authorization, or Authentication 5. Farm Product Information (use the following for farm products requiring EFS filing in accordance with the Food Security Act of 1985): Farm Product Year Quantity /Location in 6. Check Applicable Option: 7. Pay Proceeds to Debtor and Secured Party unless otherwise checked: Proceeds Covered Products Covered Secured Party Only Debtor Only Attachments EFS_Filing_Form Revised February 2016

2 Instructions for Completing Effective Financing Statement Form General Instructions: Please type this form. Verify all information you enter for accuracy and correct spelling. Any error may result in your lien becoming ineffective. Lien Duration: An EFS lien is effective for a period of five years unless extended by filing a continuation statement Acknowledgement Letter: A system derived acknowledgement letter will be returned to you to retain with your records. Please verify the information appearing on the acknowledgement letter for accuracy and correct spelling. If you discover a problem, please contact our office immediately at (307) Fees: o $20 which includes the termination o $35 if more than two (2) pages Sections 2 and 3: Debtor Information Debtor Name (2a or 2b, 3a or 3b): Enter only one Debtor name per section. The debtor name can be an organization or an individual s name but it cannot be both. Enter the Debtor s exact full legal name. Do not abbreviate. Debtor Address (2c or 3c): Enter the debtor s mailing address including city, state and zip code. ganization Debtor: ganization means an entity having a legal identity separate from its owner. A partnership is an organization; a sole proprietorship is not an organization, even if it does business under a trade name. If the Debtor is a partnership, enter exact full legal name of partnership. If Debtor is a registered organization (e.g., corporation, limited partnership, limited liability company), it is advisable to examine Debtor s current filed charter documents to determine debtor correct name. Individual Debtor: Individual means a natural person; this includes a sole proprietorship, whether or not the individual is operating under a trade name. Do not use prefixes (Mr., Mrs., Ms.). Use suffix box only for titles of lineage (Jr., Sr., III) and not for other suffixes or titles (e.g., M.D.). Use a married woman s personal name (Mary Smith, not Mrs. John Smith). Enter individual Debtor s family name (surname) in the Last Name box, first given name in the First Name box, and all additional given names in the Middle Name box. SSN/EIN (2d and 3d): The SSN is required for each individual debtor and the debtor s internal revenue service (IRS) employer identification number (EIN) is required for each business, corporation and trade name. Debtor Signature (2e and 3e): Each debtor reflected on the EFS is required to sign, authorize or authenticate the notice. Section 4: Secured Party Information Secured Party and Assignee: The secured party is required to file the lien notice. If the secured party is an assignee, please check the box. Secured Party Name (4a or 4b): Enter the secured party s name in either 1e or 2e but do not complete both fields. Secured Party Address (4c): Enter the secured party s mailing address including city, state and zip code. Secured Party Signature (4d): The secured party is required to sign, authorize or authenticate the notice. Section 5: Farm Product Information Farm Product: You must list the specific farm product such as wheat, barley, hay, cattle, horses, and pigs. The listing all livestock and crops will not suffice. : Reference the farm product codes below and enter the applicable code. Year: For a crop grown in soil, list the calendar year in which it is harvested or to be harvested. For animals, list the calendar year in which they are born or acquired. For poultry or eggs, list the calendar year in which they are sold or to be sold. If year is left blank, perfection continues for every year the statement is effective. /Location in : Number of bushels, head of livestock, or other commonly used identifier. Specify the units. Example: 300 bushels of winter wheat stored in bin 12. If left blank, then all specific farm products owned by the debtor are covered. : List where the farm product is produced and/or located. EFS_Filing_Form_Instructions Revised February 2016

3 Fax For Office Use Only Effective Financing Statement (EFS) Addendum Form This addendum must accompany the EFS new filing form and be filed by the Secured Party in compliance with the Federal Act. 6. Name of First Debtor (2a or 2b) on Related Effective Financing Statement 7. Additional Debtor s Exact Full Legal Name (only one (1) debtor name (7a or 7b): c. Mailing Address City State Postal 8. Additional Debtor s Exact Full Legal Name (only one (1) debtor name (8a or 8b): c. Mailing Address City State Postal 9. Additional Secured Party s or Assignee s Exact Full Legal Name (only one (1) secured party name (9a or 9b): Check if Assignee c. Mailing Address City State Postal d. Secured Party s Signature, Authorization, or Authentication 10. Additional Farm Products Only: Farm Product Year Quantity /Location in EFS_Addendum_Filing_Form Revised February 2016

4 Business Division Farm Product s List When completing an Effective Financing Statement (EFS) form, farm product codes must be used in the column of the form. For example, if the farm product is beef cattle/calves use 5001 in the code column of the form Buckwheat 1002 Spring Wheat 1003 Winter Wheat 1005 Straw 2001 Barley 2002 Rye - includes triticale 2003 Oats 2004 Sorghum Grain 2005 Flaxseed 2006 Safflower 2007 Field Corn 2008 Alfalfa 2009 Clover 2010 Millet 2011 Milo 2012 Durum 2013 Sorghum Sudan Grass 2014 Malt Barley 2100 Hay 2200 Ensilage 2300 Potatoes 2400 Sugar Beets 2500 Dry Beans 2600 Sweet Corn 2700 Onions 2800 Mint 2901 Popcorn 2902 Sunflower Seeds 2903 Canola Seed 2904 Cotton Seed 3000 Soybeans 3101 Grass for Seed 3102 Alfalfa for Seed 3103 Mustard 3104 Vetch/Fescue 3105 Herbs 3106 Carrot Seed 3107 Onion Seed 3108 Pea Seed 3109 Clover Seed 3201 Green Peas 3202 Tomatoes 3203 Lettuce 3204 Cucumbers 3205 Broccoli 3206 Cauliflower 3207 Lima Beans 3208 Green Beans 3209 Hominy 3210 Carrots 3211 Turnips 3212 Asparagus 3213 Spinach & Collards 3214 Pumpkin & Squash 3215 Watermelon 3216 Muskmelon 3217 Cantaloupe 3301 Apples 3302 Plums 3401 Strawberries 3402 Raspberries 3501 Sod 3502 Nursery Stock (Trees, Shrubs) 3503 Flowers, Potted Plants 1

5 Business Division 3600 Mushrooms 5001 Beef Cattle, Calves 5002 Buffalo 5003 Bison 5101 Sheep and Lambs 5102 Wool 5103 Goats 5104 Llamas 5105 Alpacas 5106 Mohair 5200 Hogs 5301 Dairy Cattle 5302 Milk 5303 Cream 5401 Horses 5402 Mules 5403 Donkeys, Burros 5501 Chickens 5502 Eggs 5601 Turkeys 5602 Ducks 5603 Geese 5604 Game Bird, Ostrich 5605 Ostrich 5701 Mink/Pelts 5702 Rabbits 5703 Fox & Pelts 5704 Lynx, Bobcat, Pelts 5750 Dogs 5751 Cats 5801 Bees, Hives 5802 Honey 5803 Beeswax 5804 Bee Pollen 5901 Fish 6001 Deer 6002 Elk 6100 Worms 6201 Cattle Semen 6202 Horse Semen 7001 Sugar Beet Top Pasture 7002 Corn Stubble 7003 Alfalfa Pasture 7004 Oats Pasture 7005 Barley Stubble 7008 Commercial Feed 7009 Radish Seed 7010 Sainfoin Revised 12/2015 2

6 Business Division s When completing an Effective Financing Statement (EFS) form, Wyoming's county codes must be used under the "county code" section. For example, if beef cattle/calves are produced in Park, then the "county code" of "11" must appear in the "county code" column of the form. See the State of Wyoming Effective Financing Statement (EFS) forms. Name Albany 05 Big Horn 09 Campbell 17 Carbon 06 Converse 13 Crook 18 Fremont 10 Goshen 07 Hot Springs 15 Johnson 16 Laramie 02 Lincoln 12 Natrona 01 Niobrara 14 Park 11 Platte 08 Sheridan 03 Sublette 23 Sweetwater 04 Teton 22 Uinta 19 Washakie 20 Weston 21

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