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~ THIS FINAFKING STATEIW9rT ~s poe~emed ro o filinp office. fo. filinq punuom b d+e Unif«m Carrneraal Codr: 3. Atiotiw~~y doa (if a~y:) ~p
1. Oebror(s) (last Name first) and uddressNs) 2. Setwd Portpl~as! and addtistl~ Fw Filinp Offion IDute. Tine. Munb~r. :
~avis, ?Zobsrt R. T ~
EAGLE ~A~~ F~M°
26~9 F~ijhland ~3? vd. P.n. ~Oh ~r~~ :
~ ?t. Pierce, Fl.a. ('~~~7 S. 1`~nLRAL
FI'. Pi~ -f ~-itV'Y.)'
F;C~, i-._7, zlllA 33450
n,is ReoncN+y ua~enw+t aarers the tdlow7np hrp~s (o. iNmsi of proputp: -"~+'i.t~
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~ As li.~te~ on ~chednle ''x" securitv list ds*ed ~-2?-75
s. ~+..1s) ~ s.ew.a aony and Adde~ss(«)
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6. The secu~d po~tylsl, whose siyrwtwNs) appwn bdow, stoas Nat the s~anP+ ~qwtid bY Clwpkr ?01,
Fbrido Stohiles. if m~y. have b~a~ ploced on ~hs promissory instniments setvrd he+ebp, and will be ~
~ ploced on a~y oddit~anol and similor i~tnmww d~ot moy b~ ot seaRSd.
This sbtemenf is Sled willwiR the deblor's siprwlvee b pt~feQ a a~turdp infeept in aolluterol. (CF»dt ~ if soi
~ ? Alroody wbjett M a setvrify inesresl in onoN~sr jurifdiclion whwf if wos b~o~qht iMO this stale.
~ ~ WFl~d+ is proaeds of the wiqinol edlote.d descri6~d abare in whid~ o ~eaxity inter~st wos perf~ctd:
~ Chedc ~ if oorered: ? Procseds of Colb~erol oro also aorered. ? Producls of Colbftrol orc olw covercd. No. oi Additionol 51»e~s presenled: .
~ Fibd wifh: ,
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~ d R~~~~~ EAGLE ~ 1."t~ci ~ CO~p ?
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Siprwn+rMs) of Debats) ' SiyrwlurNsl of ny~i~s)
~ STANUARD FORM - FORM UCC-1
j I) ~ifing Of4icer Copy - Alpha~eticaE ~d b,, x,d,o~a ~o;d~~ s~«,a, s«.~rary ai s~~, s~m~ ef Flondv ~
- . ~ EXEC. IDEAS NO. 1679
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