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f~tvAN~ItJG SiATEMES~/T is presenred to a tii~ng off~ccr for f~i:nq ~rfwnt ro rhe th~fam Crxr.mrnal Code: I
3. Akatwity dote (~f anyjs ~
;:rbior~sj ~Lost \ams F~rst) and oddrru~es) 2. $ec~red Porty(ies) and oddrex(e~) i For Fil~np Officer iDut~. Tims. Numb~r, ond filinp Offic~) ~
~ ~ :ra, 3essie P•-~,v~:ie~t `r';nance Co~oa.Ty ~ ~Q~
~ ;118 I~ve:'ue 7~2 Urar.:-e Nve^ue ~1.t~iECOUMTIr~ ~ i
~ Pierce, Mlo^:~3 .`r`rt _'ierce F'lor~da AOCERPOITIIAS 1
~ ~ CLERR C1RCU17 COU~t
RECOI~O VEp~F~EO
~ . -•^.~s f.nanurp stateme~t cavera the foltcwinp types (ar items) of property: A 1~ ~
~ - '11
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R ; A~f of the hovxhold yoods rww ar hereaftx locoted ot debror's rosicience oddrssa set forih obave.
~ S. Assiyne+{s) of $ec~r~d Porty and Addresa(aa3 ~
1 (7~her property described o
_ (Ifetn) ~
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- :heck if trva ~ T}~e stomps requ~red by UwPtsr 2p1, F.S. have bse~ ploc~d on th• promissory instrvrr.ents secured
'a.•eby, and witl bs ploced o~ ony odd:t:onol wx! aimilw instrv~nent tnot moy be so secured.
?h;s sroter.unt ~s f~led w~ihout tM debror's s~qnoturs to pe~fecf a sec~rity intere~i i~ odlotrral. (Chetk ~ if w)
; Akeody subjrct to a securdy interest ~n arwther jurisdiU~on when it wos brouqht lnto this saars. ~
_ wr~t~h ~s p•oceeds of tiw or~yinot wl{aterol d~acr~bed abovs in wh~d~ o set~riry interesi wos perf~cted~
- _._k it co~ereef: ~Pr«eads of Col{oterol are olso coversd. ? Prodexb of Collote.al we olw covered. No. of odditional Slwets prssent~d:
Fikd w;th: _Jt. S~UC1P, Ci0~7Tlt" liOllT't.^.O':SP
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:='s!iilard d00if~~ P~_~~ ~roviaent Finance ~omo?,ny ~
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Spnatwe(al d D~brals) ~ ~(s) of Sec~red Partyt~ss)
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.STAN~AR~ FORM - FORM UCC-~
- f 1' f~G~n Offkr~ CoPY - AipF+obclital
' APPra~d bY T04A /1DNA5. Sec~e-.:-r ~ -