SECURED PARTY CREDITOR FORM

Phone Number* Email*

SPC Given Name-SPC Middle Name: SPC Family Name* (First-Middle: Last) Domicile chosen of living man/woman *

This is the Secured Party Creditors Name. Generally it would be written like this (First-Middle: Last) John-Henry: Doe Or if you don't have a This is the Common Law State where you live - please
only pick the state's you live at now, in Upper Lower
middle name it would be (First: Last) John: Doe PLEASE NOTE: add ANY SUFFIX at the end of your name that is on your Birth Certificate: Case Letters i.e. "New York" NOT "NY" OR "NEW YORK'
(spelled out in Upper/lower case) i.e., Junior., Senior., I, II, III etc. Example--> John-Henry: Doe Junior. or John-Henry: Doe II. There is no
"El" or "Bey" at the end of your name unless it says that on your Birth Certificate.

SPC Street * SPC City, State [zip] *

DO NOT ABBREVIATE. Spell the Street name/all elements out FULLY. i.e., 123 Main DO NOT ABBREVIATE. Spell the City and State out FULLY. Place zip code between brackets, i.e.,
Street or 5678 Harris Avenue - Do NOT add "c/o" in front! Anycity, California [54321]

About DEBTOR and SPC Address: The address used you should maintain for a long period of time. If you are moving soon, especially out of state,
and are getting rid of the old address totally then you should wait until you get the new address. You also are not required to use the address you
physically live at especially if you intend to keep that address totally private and confidential. Also you must pick the address your ALL CAPS LEGAL
NAME STRAWMAN/TRUST (already is getting) and especially will be getting all legal notices, mail, bills, registrations, especially paychecks delivered
to for months or years to come. The address you have on your Tax Returns, Drivers License, the address you gave to Passport Division or any other
government/state offices. Use this address; unless moving to a new address totally very shortly! If moving to another state very soon, and you will
be switching the address you give to all government agencies and employment/contracts, taxes, licenses, etc, then you will want to use that new
address instead of the old one that you are abandoning soon; so please call and ask us for recommendations. If you move this registered address
later in life in the future you will need to update your filings via a UCC-3 and possibly more. You will learn what to do from us in the process, and
you can always Get in touch when needed for clarity. Do NOT use two separate addresses unless you check them both regularly and will be doing
so for a long time. Every time you start using one address and then cancel it, fail to renew a POBox, etc, you create extra work and energy for
yourself, and run the risk of missing important notices. If you wish to maintain two separate addresses for the DEBTOR vs. the Secured-Party:
Creditor than that it OK but just make sure you religiously check both addresses for any replies. This is why we recommend just using ONE
ADDRESS!

DEBTOR/TRUST INFO
DEBTOR'S/TRUST FIRST MIDDLE and LAST Name * DEBTOR'S/TRUST Domicile (where you currently live) *

Write the first, middle, last NAME in all CAPITALS i.e., JOHN HENRY DOE PLEASENOTE: add ANY SUFFIX at the end of your name that is on your Birth Certificate: (spelled out in ALL Wherever the principal place of operation is located. Usually where legal mail is delivered. Must be in ALL CAPS, i.e.,
CAPS) i.e., JUNIOR, SENIOR, I, II, III etc. Example--> JOHN HENRY DOE JUNIOR. or JOHN HENRY DOE III TEXAS, not “Texas.”

DEBTOR'S/TRUST Full Street Address* DEBTOR'S/TRUST CITY, STATE, ZIP*

Write the FULL STREET address and Apartment or Box number here, in ALL CAPS! Abbreviation is acceptable. Spell the CITY FULLY and ABBREVIATE STATE. Do NOT Place zip code between brackets, i.e., ANYCITY, CA 54321

FULL SSN * (ENTRY 1) FULL SSN * (ENTRY 2) GOVERNING LAW OF DEBTOR TRUST * UCC REGION TO FILE AT

FIND CORRECT UCC REGION HERE

Full Social Security Number WITH dashes i.e., 123-45- Full Social Security Number WITHOUT dashes 123456789 The common law of state you are located at; the same as Must be in ALL CAPS, i.e., TEXAS, not “Texas.” Region
6789 the domicile. (i.e., Illinois)<-- i.e. JUST put the State name Filing State based on where you live now; (see link to the
in like this, do not write anything else. right)

Date Born * Date of 18th Birthday* Birth State Born * How Old Are You? * Select a Notification State *

mm/dd/yyyy mm/dd/yyyy Spelled out Upper and lower case i.e., North How old are you as of the day you are filling out your data Must be in ALL CAPS, i.e., TEXAS, not "Texas." This is an
Carolina sheet. additional Secretary of State that will be put on notice of
your UCC Filing; other than the Birth State and UCC
Region state. You wil need to notify the State that you are
living at now, and the State you are doing business out of,
so you should pick these unless they were already a birth
SECRETARY OF STATE ADDRESS IN YOUR BIRTH STATE * state or ucc region state selected above. If your birth
p.s. Do NOT add the proper name of the Officer named state and living state and/or ucc region state are the
as the current Secretary of State"; also do NOT add the same, then please pick another state that you travel to
words "Secretary of State"; ONLY put the address. live near or have any court cases in.
The Administrative office address. If you cannot find the address, enter "CANNOT FIND" and we will look up the proper
noficiation address for you.

SECRETARY OF STATE ADDRESS IN YOUR 2nd NOTIFICATION STATE *

The Administrative office address of where you work, live in, or travel thru a lot: If you cannot find the
address, enter "CANNOT FIND" and we will look up the proper noficiation address for you.

SECOND TRUSTEE INFO

Second Trustee's Full Name * Second Trustee's Full Street Address * Second Trustee's City, State Zip *

This should be someone you trust deeply. The second Example: 123 Main Street Example: Anycity, California [54321] <--- Spell out State; Zip in Brackets!!!
Trustee will "have your back", not back down to protect
the Trust. First and Second Trustee need to be competent
trustees and/or at least be in "commitment to learning Second Trustee should be a Secured Party as well if possible, and you should list there name as John-Henry: Doe
about being a good trustee" for you mode.

EXCHANGER INFO
Exchanger's Full Name * Exchanger's Full Street Address * Exchanger's City, State Zip *

The Exchanger can either be the Secured Party, the Example: 123 Main Street Example: Anycity, California [54321] <--- Spell out State; Zip in Brackets!!!
Second Trustee, or another party of your choosing, but
not a beneficiary. (as: John-Henry: Doe).

Initial Property Description *

COMPLETE DESCRIPTION of initial property being exchanged into the trust, including any identifying numbers, etc. Do NOT add REAL ESTATE/HOME, CAR, Cell Phone, or anything else of high value! This is NOT the proper
trust to put any real valuable property into! CLICK HERE FOR INFORMATION ON WHAT IS AND WHAT IS NOT ALLOWED (PLEASE READ THIS!) (Best Recommendation: Pick a personal collectible item or something with
sentimental and tangible value that was given to you, or a piece of gold or silver or something that you have that you did NOT buy with a bank card)

BENEFICIARY(IES) INFO
 You must have at least 1 Beneficiary. You can have as many as you like. The Beneficiary can NOT be the Secured Party, the Debtor, a Trustee or the Exchanger. If you have Children, they make great Beneficiaries. Other options for Beneficiaries are anyone
you would consider leaving your worldly possessions to. The Beneficiary does not have to be a live flesh and blood man, it could also be a corporation, business etc. i.e., 15% (note that the percentage does not have to equal 100% among all of the
beneficiaries, as the trust can retain part of the beneficial interest aside for future beneficiaries. Obviously, the percentages for all the beneficiaries can NOT exceed 100%. We suggest highly making the percentages of the beneficiaries equal 50%. You may
also wish to select a beneficiary willing to waive their position if asked to do so.

Beneficiary 1 Full Name * Beneficiary 2 Full Name Beneficiary 3 Full Name Beneficiary 4 Full Name Beneficiary 5 Full Name

Percent to Beneficiary 1 * Percent to Beneficiary 2 Percent to Beneficiary 3 Percent to Beneficiary 4 Percent to Beneficiary 5

i.e. 15%

However you spell the name will appear on the

documents.
Include Full Middle Name.

Beneficiary 1 Full Address *

Beneficiary 2 Full Address

Beneficiary 3 Full Address

Beneficiary 4 Full Address

Beneficiary 5 Full Address

Witness *

This is the witness on the deed of transfer. It can be the 1st or 2nd Trustee…BUT, it CAN NOT be the 1st Trustee if he/she
is also the exchanger.

CERTIFICATE OF LIVE BIRTH INFO

BEFORE EMAILING THIS FORM TO UCL, CLICK THE
VALIDATE FORM BUTTON BELOW:
First Birth Certificate Number or Second Birth Certificate or Cert. Of
Certificate of Naturalization Number Naturalization Serial Number
(usually called “State File Number” in (bottom left, bottom right, or
upper right corner) reverse side of document) SCROLL DOWN BELOW (BOTTOM OF THIS DOCUMENT) FOR A VISUAL EXAMPLE OF WHERE TO LOCATE YOUR BIRTH CERTIFICATE NUMBER(S).

ADDITIONAL HISTORY
Have you done any previous UCC Filings? Have you had any legal name changes? If yes, please include these Legal Change of Name
(YES or NO) documents along with your BC.

MAIL NUMBERS
This section is for your reference only and may be done after you email us this form. Go to the self-help counter at the Post Office and get 6 Certified Mail Receipts and 6 Blank Green Cards. It will have a unique article number on the left-hand side
of the form. [PS Form 3800]. Save these to use for future step in your SPC process.

Certified Mail Numbers

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VISUAL OF LOCATING BIRTH CERTIFICATE NUMBERS

VISUAL OF LOCATING BIRTH CERTIFICATE NUMBERS
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