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THIS FINANCIlK3 STA7EMENT is pn~l~d b a FIiwO offiw for Fliup pwwa?~ b Nr Ueiforw~ Ce~w~dd Codr l. Mahwifp dm~ (if ohr1: ~
1. D~beer(s) (toq Nowr Fwsq awd oddress(~s) Z. Secw~d ~arM('wsl ad addr~nl~s) hr Fi~p Off•w (Dow. T1w~. lM+~br, ewd i'~6wY Offia) s
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:ci__:nor. c'ran Gz~er: l?in• nce ~c.~_ cr_ icr. tLEO AN~ RECOR~EO
„ ~01 ~ S. : ederrl _:i ~h•::~: y ~T.lUC1E ~OU11TY LA.
- • • ROGEfi POtTNAb
So~:.~d, ~ri~:~ ~34`-; ~:ri,~~.~-~~z;.'~C~£ad}-~"~2i'~ CtEP.R CtfCUt1 COURT
Ft, :`ierce, ~?oric:-~ 3345o P.£~QR~? VE~~FIED
t. This Fmowdrg stoMw~snf c~s IM felbwinp yrp~s (w itNws) ar ProV~f'~ ~ ~ 8~~~~~
All of th• conww~r qoods now locot~d io or obout th~ pr~mis~s censtitutiny th~ d~btws' rtsid~nc~ et +
th~ir eddnss obow s~t (orth or ot any othe~ oddr~ss to which th~ sae~• aar b• r•~o..d md mr orop..*r s
list~d b~b.. S. Assiyw~~Ss) of S~aR~d Iarf~r a~d llddresa(es)
Th~ folbv?iny oroye~ty:
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6. ,ti »w.s ov*.cal. ..~o.. :a^~cy eowd. e.+o+, wr. we. ww. ~.~ow.d a a~ao~r ao~, rbreo s~a~wer. H aq. M.. a.« ~
ob~~d on eM Po+~a.ory .naM~r~w+~ aecw~d Iw~6?, ad ~J d Obod ow e~f ad3wwl ed rwior wawrwl MaR weI 1w ~a rcw~d- .
TF.is slme~neM is fled witMvr 1M dtbtors s~9wmrr~ to petfM a secwih interest in ooNolKOL (Ch~ck ~ if w)
- Already wbjecf to a s~cvriy iMenst in anoNrr jwisdiction wMn if wos brw9hf into this sfoN.
which is proneds of tM «qieol cdbterol d~wbed obw~ iw whicA a s~arriy imK~st rras p~rfeded:
Check $:f co?ird: ~ hoceds sf CdbMol ar~ olss oo.~nd. p hoducts of Cd1eMo1 ore alw cove~~d. No. of odditionol Sha~b pr~s~wNd:
F:~.a c;. :r'~ .,f c~rcuit ccu:•t
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SiqnoMe(s) eF D~Ww(sl eIs) of S~cvr~d /wryrliesl
STANDARD FORM - FORM UCC-1 ~
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(1) Fi":,~ "r" _~r C~.~,, _ A;pha: etical ,~.d..a b„ ~.e io~~ s+«~.. SKr~tary of Stat~, Sfo1t o~ F~..,;~
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