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FORM FOR COMPLIANCE WITH REGULATIQN U
p~.~ u, ~ss+~ .
FIRST NA1'IONAL EANY AND TAUST DO~[tANY OF STUART Date _ _ _ _ _ _ _ . _ _ _ _ _ _ . . - _ _
~f
liUAt7. iIAtIDA .
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~ The purpose of the loan- made by you to the und~:?signed, evidenced by the under-
~ signed's note for - - dated ~
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~ and payable to the order of First National Bank and Trust Company, of Stuart,
~S to purchase stock re~'•tered on a national securities exchange or to reduce or
IS NOT .
retire indebtedness originally incurred for such a purpose.
The borrower further represents that the purpose of the loan is as follaws:
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~ Signature of Borrower------------------------------------------------- '
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~ Address----------------------------------------------------------------------
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~ The borrower is known to me and 1 am familiar with the dreumstances surrounding this loan. The above
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~ statement of the borrower has been aaepted by me in good faith. . '
~ FIRST NATIONAL BANK AND TAUST COMPANY
OF S?UAAT
~ ~a~K 281 683
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k
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o~ncsa'~ iIONATU11t T~ni ~
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