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~ THIS FlNANCMIG STAiEMBiT is P~ b o filinp offiox ior filinp punua+t b d~e Uniiam Canneeciol Gode: 3. Mohwil~r doN (if an~?d 80
~ 1. D~b~als) Nane fiRtl and add~ssl~s) 2. S~cund Florrylys) and addtiss{es) } For Filinp ~ . liumb~r.
~ Simmons~ Sarl ~ Fannie • ~^~C=?. :??,?-~'~:CE` .
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Ft. Pier ae, F? a. 33450 ~~7'~ ~_T~ ~,'•.f"'T' 3'•Tr' ~~~'~~j
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4_ ihis finoncinp sbMeMeu oo~rees ~ht iollowi^0 NiP~~ (w it~ns) of Pnp«~1?-
As listed on schedule "A" security list dated 9-15-75
s. /?aiqewls) ot s.cv~.a Po.h? ma Adai.aw
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g e. TM ssa~e~d portplsl, wFw~s siqiwwrMsl oPp~ors bdow, stot~s lhot the stomps r~quind bY Q+o~r Yol,
Flw~da SbAAies. if ary~. iwre bNn pbod on ehs pranis~orY imt?wn~+ri asau~d ha+sby. atd will be
~ pload on on~r odditionol ond siinilor instrunrM ~ot a~wr b~ as s~a~red.
~ TF?is stahn~N is fild witlioul dw d~bor's sgrwwn b pnc~~ o~ihr inl~tst in aotto~erol. (Chsck ~ if so)
? Alrwdy wbNct w o s~awihr inl~nq in onoMw ju~iadiction wlw~ il was broupl~t imo ~his qore.
Q Whicfi is qoo~eds of th~ orqinal oolla~d desaibd abw~ in whid~ o ~eaxiqr in~aest wot paf~ctd:
Uwck ~ if aorend: ? Pmoaeds of Collolerd or~ alao aora~d. ? Producls of Colb~al ~e dw corered. No. of Additionol SF~a1s p~es~nt~d:
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STANOARD FORM - fORM lKC-1
(1~ Fifi~g Qf#icer Copy - A1pFiabetit.~ Appomed bp IKtlwrd (Dick) Swrn. Sec?etvry ol Staro. State of fiwide,.
- E~C_ IDE/lS NO. 1679
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