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TMIS FINANCIN(3 STATEMENT is pr~s~nNd b o filinp off'wr fa filuq pxnuant ro tM Unifwin Co~ciol Cod~: Moturifr dote (if awy)c ~,Z~10~ B
1. D~Mw(s) (tosl Non~ Fnfy and oddr~ss(~sl 2_ S~cvr+d ?orl~(i~sl ond address(a) ?er fi.y ON~ar IOw. rrw. Nr..b~.. a.d i~'ry OHin)
tt~aaick, Ltiiie ~a i~t ingra.t, x~.~ ~iia~s,
3113 Av~ts R ~j~ w~~ ED AND RECOROED
~ ST lUC1E COUNTY. FLA.
Ft. Pie~ras, Fia. 3345o s I?`t. Pieras fla. 33450 .FCORn v~RiF~~o
t. This f' '
r~anciny .taNw~snt co„u. M. rolio,i.irq ryp.. cor i~.ia., aF prop..q,: C~ s 'O ,~O
asv 1lf~i8 if~sti~gttiorss R~t~gs Xoisl REA-3H 9es ~2052lt9 'sg •
nsv 1968 iiastinAhenss N xodei ~92#29,~ Ssr #16To85 ~
S. Assiq~w~(s of arh and Addr~ss(~s)
asv 1968 xoea xoasi 53-1230 ~ o R~o ~
• ~ EF2K CIRCUIT COURT
6. Ch~ck if Mr~ (~Th~ s~aiwps ?puir~d bp ChaW+r 201, f.S. how b~~n ploc~d m tM prow~iwarr inshwMnts t~cw~d
Mnbr, ond wiq b~ pbad en mr additiond ond sisilar insfrww~nt N~ot wwr M w s~cvr~d.
. i1w sbNn»nt is fiMd withovt tlr ~Mblw's siy~whrn 1o perf~cl o s~cwihr in»r~s1 iw colbNrd. (CMck ~ N w) '
? A6~adr subj~tf b a MtwilY inNretf in anelh~r jwisditfian w1Nn if was brwQMf iMO Mi~ s1aN. '
? whieh h pon~d~ of IM wiqinol collohral dewib~d abov~ in whkh o s~cwif~r int~s~ was p~rf~c»d: ~
s CMck ~ if cov~r~d: ~ frocNda o/ Co11dKd w olw c~wr~d. [~hodych of ColbNrd on olso cov~r~d. No. of oddit~awl Slwb pr~nt~d: ;
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` Siyiwer.~(s) D~blw(s) Siynotw~(s) of ?w1y(i~s) •
, eoa~174 ~2i- STAN~ARD FORM - ~
~ (1) ~ O~Ap~ C~ • AI~ APWo•~d b~r Tas Ada~s. SwNOrr of S~ol~. StoN vI Hwida