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THIS FINANCING STATEMENT is presented ro o filirq oRioer for fil' pwsuant to tM Unitorm Gorm~srciol C,odw 3 dat~ (ff
{~~1~r, and filieq Offiw)
l. D~btar(s) (loat Noms Fint) a++d oddras(u) z s.a..a ea.,,,c»~~ ~a oea~...c.,~ ,y . WCIE COUNTY F~r
Ya~ighn~ Do~is S. Ge~e~al Finanoe I~oa~ Caog~aqy ~-`-~ORD VER,FIEp~A.
2~py Drl~antr~ _ 21Q1 South F~sde~al Si
Ft. Pia~ce, Flosida 33450 1''t. Pie~ce, Florida 3349~ 'j~ Y y~y 10 : Z
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- s.-Tt~tslt~Grsq~ra?ertars.-~rs,?w ta,tewte~q ryp~s cQ ts.ms) of propw~ryr.- - G -
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~ N~ oF +h. houa+ho+a v~ i,a• a?~r+« bca+.a ot a.bmr. ..,;d«~o. oaa..s. ,.r +«,n obw.. C R K C! R C U t T
O al~er Wo~tY desaib~d oc S- Asdyrwe(s) of S~a+~~d Portr w~d Addr~ss(~s)
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6. O~etk if tn~ ~Tiv sfanpa nquir~d b~r C7~opt~t 201. F.S. !ww b~e~n piond m d» pramistwr inst~wna+ts s~aa~d
M?~b71, and wil{ b~ ptoc+d on ony additiotwl ord similor instrua+~nt tha~ may b~ so aecund:
This srat~nrnt is fi1~Q witAout tM d~bors sipnatvr~ b psrf~o a a~cwity inbnst in mltoqrol. (C~wdc ~ if w}
?/1kwdY ~i~d to a a~cwit~r inw~st in anoth+r iu?iad~dia+ wF»n it was brwphl iMO this aMt~.
Q whid~ is prousds of tM oripirwl Qolloterol droib~d abar~ in whicA o wcwiy int~req wos Perfed~da
CMwd~c ~ if oovx~d~ Q ProcNds d Colioterol on olso oowr~d. Q Produus of fallm~rol an otso oowr~d. No. of additionol Slw~s prewnbd:
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M ~'r° Spna~tun{a~ 01 S~OUr ?~t~ ~
Sipno~ur~(S) of D~b~o~W
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~ Appror~d b~r iOM ADAlotiS. S~crerory cf"Sra?e. S?.•a of Ptc..
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