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THIS fINANCtNG STATEMB~lT is prcsenfed w a filiny oHicer for filinp purx+om to ~he th?ifam Comnerciol Code: 3: Fhoturitp dot~ lif ony:) 1'1- ~
1. Dabtor(s) (last Nome Fint) and addressles) 4. Sccured Portyliesi ond oddressles) for Filiny Offioer (DoM. Time. Nuinber. a
*~avis, J~hn Fi, u g AGLE ~'II~Tr~.NCE , _ ~ Fi~ orF~~ ~
~,ar aret B~X 3 65 1
3 Rox 6o9-R ' {
» t. Pier oe, FLa ,~~1~5p 2C~57 F?sTJERAL HWY.) ~
~ " i'. PIE~CE, TL~RIDA 33450
~ ~,n fi~,~ ~ ~ ~ 2997'23
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As list~=d o~ scred~ale "A" securi ty list dated 11-ll;-71:
~ s- Assiynetls) of s.nK.a Pb~ry, aea Addtissl..)
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~ 6. iF~e sec~w~d paAy(sl, wlwse siq~wlvrc{sl oppeoa bebw. sfotes fhof ihe slomps rsquieed by Chopter ?Ol,
~ fbrido Stotules, if w~y, have bee~ ploud on M~t promissorY instrurnents secwsd hereby. ond will be ~
ploced on a~y additiorwl ond similar instMr~enf that may be os secwed. ~
This stotan+ent is filsd wiMaut the deMa's twe b o ~ntaresr in colloterol. (CMck ~ if wl ~
agrw Pafrct sacw~h ~
~ Q Alroodr wbject to o aawity u+terest onoN~ jurisdiction wMn it was brougf+t into this sta~e. • ~
Q WhKh is prooee~ls of the wiginol oolloterol described obwe in which o sec4rity interest wos perfected: ~
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Check 0 if aorered: ? Woceeds of Colloterol are also covered. ? Prod~cts of Cdlattrol are also corered_ No. of Additiawl Shee~s presented: ~
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B~OX ~?t~7~.~ P~I'iE r• ;
~ r,A!.~,E FI:i~'.NCE CQkP 1
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~ eY~ S~yiwturNsl d Dsb~orls) Sigiwnxelsl Pbnyl~es)
~ STANDARD FORM - FORM UCC-1 ~
~ - Alp6akieticat
~ ~ j~ F~~'r;g Off~cer Coo• Approved by Rid+ord IDickl S~w~e. Sec*e~ory of Sto?e. State of Ho?ido
~ ~ , ~ - . ~ ~c. ioE~s No. i e~9
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