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n11S HwwcudG sfwtEME~IT is pies~d w u fiw+p offiw w. Rl:~p qw+uon~ w an unitw~n c~~ol Goe.: 3. M~o~u.~h? do~. t~ ~rl 12-
O~b1or(sl (l4s? Name ~irst) and odd~ 2. S~w+d al _ For f,lpg F~ tJuenb~r.
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Adams, Caretha ~ r AL H«'~'•)
100 Devonshire ~Jr. ~ p~? FLD~.F~
Ft. Pierce, Fla. 33450 l, j~jT~ zCE, F~-~~Y~~' 33450
a. This flnonciny s1al~n~nt aaras tM idbwi+~ tpVw (o? iw~wl d poprl~r:
As listed on schEdule "A" security list dated 12-2-7~t
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e. n» ~.w.d pa+r~sl. aPP~s b~low. ~s Aw~ ths stomp. r~quind br Uwp~r TO~. _
Fbrido Swlules, if airy, hare bea~ piaod m th~ pra~wstaY iuttuments sawd IKre~r. ond wilt b~
pluced an onf? adfiitiorwf and si~wilor ititrumwit dat a~a~r b~ os sww~d.
This stoNrnMM is fiMd wiNwur fhs dd~lor's signo~ b pn(~ o Mawif~r inlwat in colfolerol. (C]rd~ ~ if sW
~ M~odr subj~c! b o s~wrih i~+M~eu in aew~FN? jurididion wl+~n tt wos ba+dM n1o Nas stolt.
Q Whid~ i! pfowdl of Ihe or'g'Mwl ooHWad d~suib~d abw~t in whid~ o fsaKify inlNest wos pai~dld:
CFNtIc ~ if torehd: ~ PeooNds d Gollots~d a~ olso oovewd. ? h~oducfs of Collotanol ott olto cwered. No. of Additionoi Shens pre~a~Nd:
Fbd wi1h:
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STANDARD FORM - FORM UCC-1 .
(I~ Filing Gff+cer Copy- AI~}iaEietieai ~w.e by t~dw~d IoK~1 s~«+~. Sec?e?ory of Storo. Stote of Fia~do
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~ EXEC. IDE/~S NO. 16~9 -
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