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THIS FINANCQrG STATEMBJT is p~aserM~d b a filinp offic~r for filinq PunuoiK b Ih~ Uniiw!e Conrr~ncid Codt: 3. MohMily doN ('d aehr.l
1. Oabso~s! (lost Naine FHSt) ond oddress{es) ~v~ ond addnss(as) For Filinp Offiw (Oo~s. Trne, Nun~r,
~t1•~ I' t t\ A.~~ and Filinp Off~ ~
SYsas, J. ~ Unrothy P.n. BOX 32C5
lt213 Av H ~ PIER~ ~~FtAL f~'tVI'.}' ~
Ft. Pierce, Fla. 33l~50 ~ FI.ORIDA 33;~0 a;a~~~
4. Tha ~inonci~p stoMmaM aoren N+e follo+rieg ryq~ (a itrns) of prop«1~r:
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Aa liated oa achedule "A" :ecurity list dated 6-22-76 ~
s. /lssipn..~s) ot s.~,r.a Pwy? /ledwsp.,1 ~
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6. ihe ietud patrylsl, whose siqrwturtls) oPp~on b~bw, sto„s thot Me ~w^~ps nquitid bY pbP~ ?Ol. 7
Flarido 51ohi1es, i( ornr. hov~ b~en plocsd on My P?omiatory wWnwnu+ls s~nwrd herrby. and will bt ~
ploc~d on wnr additionol ond si~nibr imtrumwM thot awr b~ os ~nwd. ~
This stotuneiq is tiMd wiN~out 1M deblor's siprw~we b P~?iKt o teawih irN~nst in tdblerol. ICf~dc ~ if ~ ~
? Alrwd~ wbNd w o sacw~ty interest in aaNwr ju?ediction wl+w~ it ww b?wyAt inb this do~e. ~
? Mlhich is pocwds oi tht orginol aollahrol dauibed abare in whid~ o s~nRily iMaest wos p~rhdd:
Ch~ck ~ if c+arend: ? Procs~ds of Colbterol ore aho ooveed. ? Producfs of Colloterol we dw oov~rod. No of Additionat S~~ee~s p~+td:
Rld wi1h:
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. s) of Debais) s) of Por1~r1»s)
STANDARD FORM FORM lK -
, (i) Filing OfficBr Copy~ %~~~~}t~~ Mv~'~d b~r 1!'id~ood (oact) S~o~e, s.v.rcry oi sw+., S~ofe oi Florido ~
. - 5~ EXK. IDEAS NO. 1679
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