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THIS fIMAMCIMG STATEMBJT is preseM~d b o filiig offioer fw Blinp pur~~on1 b fM Uni/am Conrnentiol God~: 3- IlAohwitp doN (If oMr:) 9~80
t. Ocbor(s) (loit Na~n~ fmt) and addessl~s) 2. S~cve~d Pbrryr(issl ond oddnssles) fo? Filinp Offiw~ 1Do1e. TinM, tdun~,
"ti ller, Jr. Marion & Carolyn ' - . • ~ °"d
902 Av H ~ ~
Ft. Pierce, Fla. ?3450 . j
. . " ~ _ ~ 315.58$ ~
4. 1?~is ~if1o11cin~ f1o1lnIMM t011efs Ihf fd~0'WIf10 f~~ ~O? itMM~ o~ pNOpNfy: f
As listed on scl~edule "A" security list dated 9-5-75
s. Assi~,..ts) of-s.cv..a Po.fy ona ~?dan~.W ~
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~ Fb?ido S~okAes. if wry, ho~ bsw~ plood on 1!y pranisaory inp~uments a~cw~d he~. and wdl bt
ptocsd m onp oddfionol and si~nilor ieutn~n~eK thot ~nap b~ os rarnd.
This sbMMiM 1! fiMd wi11wIR the d~bb?'s ti{/wRrr1 b pM(W a NMiy/ i~MMest if1 tolblerol. (C1~~dt ~ if so1
? Alrwdy xibNct to o rawilp in~ in anvM~s? jutisdctian wl+~n if was bto~rpht imo Ilws ~tvMt.
Q WAid~ is p~ocaeds d Nw wipinl aotlo~uol deacrib~d obar~ in whid~ o ~sawAy imerat was perf~cNd:
Chedc ~ if ao~~d: ? Proceds d Collote+ol at olso aore~~d. Q Producb of Cdbarol on olso m~nd. No_ of Additionol Shee~s pnasMSd:
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STANDARD FORM - FORM UCC-1 ~
(I} Filing Officer Copy- A1pFebeficel Mprwed by It~ord IDKkI s~ar, s.o.+an s*on. s~w. oF Ro.~do ;
/ - _ . _ ~ f E7~C IOEAS NO. 1679
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