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~ ~ FIN/1fJGlNG STATEME:iT is presented to a filiny oificer for filing µxsva+~ ro the Uniform Convnerc;ol Code: I 3. AAoturiry dote (if my~z/7/78
~ ~ vebea(s) (last N«ns First) and wldress(es) ~ 2 Sea~red Portyliss) and address(es) For Fi?iny Officer lDats. Time. Numbsr, md Filinp Office)
a ;o~em~;,n, Jor:n & C~~rol i;~_: er :l ~'ir~ance Corpor~;tion f`l~0 AND RECpRpEo
3 ~J ~ Ge_~an L'r 301c S. Fec:eral i:wy tT.IUWE COUNTY FLA.
~ - j r t. F`ierce .'la. ~>450 CIfR~K Ci~'RCWt~COURT
= t . ~ ierce, :1~ . 3~.5~ ~
~ RECORO VE~tf~Ed
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~ ~t 1~ ia a9 ~N'T3
~ »'n s finoncirg atatement covers ths foltowin9 types (a itmis) of property: -
~ All of the hovsehold floals now or hereaher lecated ot debta's residerue address set fwth obove.
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; Other prope(ty describd os - 5. Assiynee(s) of Secwsd Porty ond Addreas(es)
- 2'7Q54S
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- 2'~Q546
_ _heck if true)Q The stomps required by ChoPter 201, F.S_ havs bea~ ptoced t?+e P~om~ssory instr~mer~ts secured
r:ereby, and w~ll be ploced or. ony additional on~ s~milar instrurtxnt that rnay be w secwed. -
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?n;s starernc~t is filed v`ithout ths debtor's siynat~re ro pe*feU a xc~rity it~terqt in tollateral. (Chetk if w)
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; Alreody wbiect to a seo~nry interest in anothu jvrisdiuion when it was broupht into this state.
y wfi~cfi is uoceeds of the enqinal collateral destribed obove in vih~d~ o security interest wos perfected:
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~ -_•:ic ~ if coreredi Q Praeeds of Col{oterol as olso cove~ed. ~ Products of Cotlareral ore alw covered. No. of odditi«wl Sheets presented=
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iiled with:
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~ ~ PACE~~ ' _ - Cc~: oi~
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3 ~ - ~t'f--'i gy. -
f;~ Spnatwe(s) d Dsbtw(s) Sipnot~re(s) of Secured Varty(ies)
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STANDARD FORM - fORM UCC-1
';n ' Qlf'~<. Cor~y 41phnF~rticel
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APV~w~d bY TOM /1DMAS. S~c'et-'r : ` . -
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