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THIS flNANCING STAiE/MBdT is pnsnM~d to o fitinp ofRc~r for fili~p pu~rww b tM Unifam Cannariol Cod~: b 3. IlAahwilp doM (ff ~l 80_-..
1. D~blorlsl M~t Nonr Fint) ond odde~saMsl 2. S~nw~d Paryrli~s) and add~l~sl fa Filirg Olfiwr (DoN. Ti~n~. Numb~t.
Baker, daaies F. t~ Lynnie FA,GLf~ 1~CE ' " d+aw~or~
957 Fra Mar Pl. P.U. L~~~; -'•5
Ft. Pierce, Fla. 331t5~ (2'~5'' `-~V?3~~i~AI, H~Z1'Y.)
Fr. r.~--. a 3a t~o `~j~!~~
n~is Rnanciig stote~.~» oor~s ,!r +dlowinp 1~p~. fw ~+.ma) d prop..~r: . -
As listed on schedule "A" aecurity list dated 9-].2-75
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6. lhe s~c~wrd portrts), wlw~s sipnopa~(s) opp~on b~low. stst~s Nwt the poc~s nquind bp UapMr 201,
~ Haido SbMa, if u^Y, la~e bea~ ploc~d an th~ prom~s~o~1/ ~ts s~cwrd harab~r, and will be
~ plowd on anr od~tioewl ond sienilo. i~wru~ Nwt ~ao~r b~ os s~nw~d.
~ Thts WNnwM i~ fiYd withaK 16t deba's siywhwe b pni~0 a ~ouriqr ier~e~st in cdlate~ol_ (GMCk ~ if so)
~ ?/1Mwdy aubNct b a s~cwify int«esf in orqMMr jutis6ction wi~n i wos brouylN iMO tl?is afolie.
~ ? Wl+ich is powda of IM or:pinol adfoarot dewibed abwe in whid~ o s~cwiry iroMSt wos panc~Nd:
~ CMdt ~ if cw«d: ? Procwds d Cotlorerol at oho eov~~d_ ? Froducri of Gollolerol we olso oortrd. No. of Add~tiaal SMNS praa~Nd:
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~ STANDAR~ FORM - FORM UCG 1
(1~ Filing UFfit~3t Capy - Alp~ie~ficaE Approv~d b~r 16d+ord tD~ck1 SwM. Secrerory of Sw~s. Sra+. of Flo.;do ~
!.:i _ ~ EJ~C. IDE/1S NO. 1 e79
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