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~ TH15 flPlANCIIdG STAiEMB~lf is pe~Md b o filag offiae~ for R~i^D PK~K b dr ll~iform CorwnMriol Ca~4: 3_ AI1ohKiry do1~ ~if ony:) t
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4. This Rnanc~np stotsn+wn aove.s_the fdlowi^Y NP~ (a ~s) of pnop~ny: . ~
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~ As - listed on s chedule '~A" security list dated 8-18-75
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~ b. The ~cwrd po~rlsl, wFare siqnofur~(s1 opp~ws bMow. slotis Nwt the stomps nqui+d bfr ChoPM 201,
Florido Sblufes. if o~y. how 6~w~ plootd on th~ promistwy imtrun~ts ~cw~d har~by, ond will be
~ Pload on an~r odditioral ond sinulor imtn~rynt N~ot mop b~ os ~ea~nd_
~ This slat~nwM is 6Md wiNwut 11r debw's sipiwlun b p~r(~Q o
~ Maui+p a+~aest in collote~vt. Kh~ck ~ if sol
~ ? A!?wd~r s~+bNd b o wcv~itp infMest in wwdrr juriadiction whw~ R wos baiq!?t iMO N+is poM.
~ ? Whicfi is promds of N~t oripinot oolb~d describsd obws in whith o sxwiry interes~ wos per(~cNd:
Chsclc ~ if oorered: ? Nrocwds of Gollcterol ore also cwa~d. ? Roducts of Colloteeol o~e olso coverod. No. of Additiwwl Sl~se?s pres~nNd:
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~ STAN~ARD FORM FO C-1
( Ij Fiiing Off~cer Copy - A1~haEiotitai llpp~wed br IKdwM (oKk1 Sw~+e. 5~c.~to.y os Swfs. Sro?e oe F1o.~dv
' - - D~C. IDEAS NO_ 1679
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