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'H;S FlNMlCINCa STATEMENT is prese~ted to a fil:ng officer for filiny purswnt to the tk~iform Com~erciol Code: i 3. lJaturity date (if any): lz/31/7g
( f Debtor(.j (Lost Nams First) and oddressfes) ' 2 Socvred Party(ies3 ond odtlress(p) Fw Fifirp Uffitcr (Date. 7im~. Nun~b~r, and Filinp Offit~) f
~ ::i~l; _.~rnie c: '~o~by .,e_^.er~? ~insnce Co: poraticn i
~ ~::11, ::ve K 301~ S. :'ec?eral i~~r;~ 0!?MS ftECOVE~ ~
='t. Pi rce, Fla. 3:d50 ~`t. .:e: ce, ~'l.a. ::450 • ~B~OCE~R
P~1'~ItAt~
~ CIERK CSRCUI~ CDttR?.~~ ~
~ ItECMt~1 VFR~FtED~....~..~.. ~
~ `A >
~ 3. 7his fenoncirg storernent tovers the foltowinp types (or items) of propertY: ~ ~ . i,j s~~ ~
~ ~Y 1 £
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~ ~ All oE the Awsehold qoods naw a Fereafter bcated af debtoi s residerxe oddress set forth above. ~
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t Orher property dew~bed as 5. Assigneeis) of Secured Party o~d I~ddrrss(es) ~
s (Itemy {
c'71735 . `
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: - ~'~'17?3 ,
' .--Check if true j~Ths starnps requ;red by C}wpter 201, F.S. have-been ploced on ths promissory instruments secwed (
~ ~creb ana w~ll be
~ Y, plote0 on ~y oddit:wwl ond similor imt~u(rrent ttwt moy be so secwed.
~ Tnis staternent is filed wlrhout the dcbtor's s~pnoture to perfecf a securiry ~ntuest io coiloteral. (CJrock ~ if so}
? ~ Alreody s~bject to a~a,r~ry i~re.est in ~notner jwisd~u~o~ wheo 3t wos brovpht in+o this :tote.
Q which is praceeds of the oriy;ml ccltateral descr;lxd obore in which o set~riry interest was perfecfed:
? ~heck ~ if co,,ared: ~j Praecds of Coilaeerol ore also mvered. ? Pr~d~cts of Collaterol ore also tovered. No. o{ oddit~onal Sneets prese~led:
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~ gY ( OF ~lbfo~(f) (3) Of $K~Nld POf~Y~il3) .
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~ ~i~ r;l~^g Of{;~~r Copy-Afphobetical STANDARD FORM - FORM UCC-1 d~~ ~
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Apprrned bY TOM I.DAh15. Sec-e',-r r FI;- ja
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