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i t ~ r ' ~ . ~ _ _ II I . V _ . _ . . . ..~t 'N:S STATfMENT is precented to o filinp off:oer fa filinp purwant to th~ ltniform Cornrisrdol Cod~. I 3. Mo~wi da~~ (if any)• -i. Debfor(s) tlc~t Nan+~ First) otd oddr~ul~s1 2$eoured Po?~Y(iss) and otldrw(~s) for Filitg OHicw (~a+~. Twro. Number, ond F~I~rg OFI'a1 TREAT~ CHARLFS 0& l~lARGIAR BLAZER FINANCIAL SF.RVICES~ INC f tED AND RECOAp~ ~ 2506 S. Federal High~r ~ R C~E POITR S~ 2806•Brantley Rd. ~ Ft. ~erce, ~ 3345o Ft, ~erce, FLa 3~t5~ Rf ORQ YE~i~F1E0 C4{qtt - ~ 28783li Bk 230 Pa 469 ~ 3! ~ ~ ~M.~~~ ~ _ 4. Th~s stotert~e~+t refsrs 10 ori~inol Financinq 51ofNnent b~winp fib No . F~ied wid~ aSfi• Ll1C~.@ CiOllTlti3/ oa~. Fiha ~ 7~2~?4 19 ~qQ~~ S. Conti~wtiort. 1}~s oripinal fw~onc+np stahnw~t b~fws~n tFr forepoinp D~blor ~d Ssnrred Parh, beorin0 (ib nua~bar slwwn obow, is stil e iw. b. p isrminotian. _ S~a~nd ve?N no 1a+9~? cloim~ o sswltY intw~t undsr tM fi~wncinp stoternent beorirg fil~ numbu dwwn abwe- - 7. [j Assfp~rn~rd. Th~ secu?ed P~hrs riyM w~d~r fh~ f~~orcirp slatert~ent bewinp file nurnbsr ahown ohow to tM prnperN dewib~d in It~en il has boert oss~qned xs b th~ aasiprw whos~ nacm and oddr~ss aPPew in lam I1. 8. 0 Mrndrmnt. Finorrcinp Stot~nrnt bwrirp fil~ nurnb~r aiwwn abar~ (s anrid~d w s~t fath in Itam I1. 9. Wlwt~. S~aired-PartY r~Moa~a dr aollol~ot d~acribd in Itan 11 bom Nr finanunp sfot«rnnt b~orinp fiM numbar slawn dwve. 10. ? Circic if trw. Atl docunwntory stamp tax~s du~ and D~N or b betnrns du~ ond DoWbl~ P~+rK+a+t b G+optor 201. P. 5. hwe bn~ poid. I l. No. of odditionof she~ts prwen~sd: BIA2ER N IAL S INC. ` - ~ t ~ ~d a,,:, Si~onx.W of D~b~orW Grrns+aY onb ~ tr«n a is app aabb). Siyrwh+nf+) of Sau~d ?ortrtiss) - ~1~ Filinq OfficEr Co~y • A1 hobetical STANDARD FORM - f~~ ~:G-3 P /lpyrw~d b~r iOliA /1DAM5. Satireso ti. t - ' : ~ - - - ~ - . . - - - ~ - ~ ~~n' - ..~~.~.Y~. _ _ ,.q.. , - +Ti~.." r~sa ' ..~f ~ . . - . , . _ ._w... - '~b -..~L: . - . ~ . '3