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I` ~ ~ - ~ ~ i r?i~s ~w~wcu~G S7~tE~e~rt K p~semed w o fiia,p off~ce~ ro~ st~ p,»uo.,~ w~he un~ia.~ commMC~ol code: 3. 11Raiuiiry-do~~ (if any:) 6-?9 1. Dabtwls) (lost Nane Fies~ ond addressla) 2- ~~hl~esl ad oddresslesl Fo~ Filing Offiax I~~. Time. Nueba, I ad Filirg Offios) ~ St.c~ne, Scott R. June :'a~? e~'ir:ance ~orp of : P = p0 Box 705 20~? S• ~'ed ~'WY ' ~ 3a~m ~i*~, - ?,~,ort ~'t. Yierce, ~la. :31~50 ili~'~J~v~. ~ ~ ~ ihis ra~oncinq s~o~nnsx oo~rs tF.e fdiowirg t~rqs (or ~~ems) oi piop~rry: ~ '~s ?.ist~d on schedule secu:~ty list dated 5-20-74 s- Aoigneets) ~ s.a+rod P~? aid Ada~.s.hs) ~ ' ~ 6. The seawed portrlsl, whore sqwhrrels) oPP'~~ bebw, s~o?es lhot the stam~~s rpuwred M C~wp~e~ ?01• ~ Florida SWhAes, if u^p. hore b~en P~oced on th~ pram~s~orY instnwnents secwed he~ebY, and will be plooed on anp odditiaal ord siAwlw i~atn~nant Ihot mop be os secwed- . ~ This sioteme+N is filed witFwut che debbr's sigr+aw?e b p~:fect a sscvri~y irKetes~ in colb~erol. (CF~et1c ~ if so) ? ~/WeodY s~,6~sd ~o o s~cwitY imsrest in anod+er jurixMc~ion wFwn it wos bought im~o this s1a1e. t - ? Which is prooeeds of the orgwwl aollo~ol descn6ed obare in wi+icfi a seew~ty irue?est wos per!«~ed: ~ ~ 3 Check ~ if cove~+d: ? Roneeds oF Colb~erol ae also owered. ? Produces d Colloterol are olso covercd. Ho. oi Addit~onol 9xe~s presented: ~ Rtad wifh: ~ s ~ ~ ~ , 1 ' C. ~ ~ ~ - ~ ~ e'~. • ~ ~ o-~- _ Sgnonwe{s) of Deb~alsl j / -.'S' ~ ~ t1 - STANOARD FORM - fO12M lKC-1 ~ ~ 5 F"r ~~~{;.n• L; ~~r _ A?phabetiea[ ~?vw~ bY R:~w+d ~o:~l s~o~. S~r~T~fary ai Srose. State ~f Flo~~~.'.~ , , , . - . ~ , , ~ ~ EXEC. I OEAS NO. 1679 - - _ , ~ • ~y,+~~_ ; ' _ . _ " .----T_ ~ y~.,` ~W-~ ~~r~'" ,'k ~?.r.g"~'~'r ~,.w'-. ~ - . . . ~ ~ ~,~y ~:l- - y... _ . ~,a':-'°.~ .