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~ i~KING SUTF/NENT es pesaw~~d to o f:l:ng ofl:cw iw fitieq pws~ant ro tIN Uwifww~ Cawin~rciol Cod~: ~y~ Mb1w~h ~(if awr): NOfI~
1. Debtalsl (lost Nan~ F'vst; ond oddr~sstesl S~cvr~d ~orrylies) and addr~ss(es) w; tr w..M.. «r Ort:c~i
Daigaaa, da~ra & uni~?enal c.~.T. Ge~it companr ST~ E C UN~TYR.~F~l.A.
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x~~ RE-C10R0 VERIFiEb
: 53?5~80
trt. r~.~o., ~a. .'6 t~R I S AN 51
< This (inancin0 stoNrnenf co~~ts IM foHowi~q hpes (o~ ib+wsl ~ P~~f= . .
' ~ All of the household gooda now owned or hereaiter n 0 ~ L n r'0 i 7 R~ S
: Check scquired by Debtor and wherever loewted. • _ . . nee.KSi:.)
~X~r ~ Motor Vebicle~ F~ ~117Q~~8 ?it1~ 18709911
~ Other (des~ribe). ~
' 6. CMck if hw~ Th~ stemps ~eqri-ed br CAap/w 201. F.S. hon b~M~ ploud on Nr prw~issory insh~rwrnb s~cw~d
Mrebr, or~ ~p b~ p{x~d m on~ odditiawl w~d similx imhwww~f thd woy b~ w s~tuted.
This ard~~ ia fibd r~Mont Me d~Ma's siyew~w~ ro pwi~ct a s~cw3y int~rat in cdloterd. (U~eck ~ N se)
Alrsody sut~ct fo o secvrit~ inNrest in eno~Mr jwisdictiow ~rMn i1 woa bro~g~M info this s1oN. -
~7 wAich ia prx«ds ot ~M wiyiwol cdloM.ol describ~d abeh in v.1~h a s~cwi~r inNresl wes p~?(~cNd:
' C heck ~ iF cwr«td: ~ hxeeda o4 Co11aN.ot an dw cowr~d. ~ frodrds of ColloN?el olw coYw~d. Ns. of odditiawl Sh~Ns pr~s~whd:
filed witA: - '
' Univenal C.I.T. Credit Canpany .
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Siqnohrr~(s) ef D~Wa~is) ~(sl d /a~h,its)
- STAN~A~~ FORM~~1 ,
, ~ AaptowJ bp Tow~ Ado~ls. SwNory of Srcts. Sr~~e c~ Ro.:So '
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