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~ -•~AtYGiNG STATEMENT is presented to o fil~rq officer for fili~y pursuant to the U*+tform Comrnarciol Code: I 3- Motwity dote (if a,,,~: 12/7j78
~ lr;sl (lost Nars Fint) ond oddres>:es) 2 Sewred Portyties) ond oddress!n] For F~Lny Otficer (Date. Tims. Nwnbar, ond Filirp Office)
~ ler..,r-.' rinsnce Cor~ orz.tion fIlEO AyD RECORDEO
r~n~ Cli.'f'ord .•.alcrad P r
~ ~ '?;8 3C~1.: S. I~ederal ii ST.IUC~E ~OUNTr fU.
~ ~ ~ ROCEF PO~TRAS
~ . ~erno, :1a. 33f.57 r t. ri e~•ce, FZa. >~450 CIERK Cr:~Uit COURT ~
~ P.ECORO vER~FlED
~ ~EC I+I IO va AM'~3
~ - .=.nac~c:np statement cavers the foliawirp types (at itemsl of property+
~ ~ A~I of rhe kovxhold yoods rw~a ar Iweoiter bcoted ot debtors residence add~eu set fwth obove.
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° ~:r,er p.cperty ti~scribrd a 5. Assiynee(s) of Secvred Pnrty and Address(es)
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( Itcm)
2'70544
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~f ~.:~s id T}ie stm~ps req~~red by (3wPter 201. F.S. hava been ploc.ed cn the prom;u«y instrurnents secwed I
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-.--o~, ond will be daced on ony odditional ond sim~lor i~strument rhat may be w setured. ~
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~ ; srorcrnent is fited w~~out ths de6ror i s~pnoture to perfect a security internt in cdlaternt. {Ch..~k (~'j if so)
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A:reorly wbjM fo a xarnty iMpest «n anofhe~ lwisdiUicn when it woa bro~ght into fhis staTS.
«n~d~ is proceeds of ths wiyinol colbteral deur~bed abore in which o sec~r~ry interest was perfected:
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if mvered: ? Proceeds of Collate~ol ws olso mvered. 0 Prodvds of Colloterai are olso covued. No. of odditionol SMeet: preser~ted:
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~ Siyrwtvr~Es) d tw(s) ~ SFynarur~(sS of Sec"~red Party!iea)
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STANDARD FORM - FORM UCC-1
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~ Appfwld b~r TO11A /1DAMS. $~cretarf S
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