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4'7181'7 ~ ~o.21FL•1 Ed Nov. '76
STATE OF FLORIDA
UNIFORM COMMERCIAL CODE -FINANCING STATEMENT -FORM UCC - 1
THIS FINANCING STATEMENT is presented to • filing officer for filing pursuant to the Uniform Commercial Code: 3•
t, Debtorts) (Last Name First) and Address 2. Secured Party and Addres * For Filing Off'werlDste,Time, Number,sndFiling
Office)
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4, This financing statement corers the following typeslor items) of property: (Check box which opplles/
Ad of the household jurnlrun end furnit/rir?a; electrical and acs appliance; tncdrdt~ televenon
®.tett, phonodnaphs end traced phyer; rcjrgesstor; etc, and other permnal property now owned
and located et the naidence of the Debtors et the eddressaiven abovr in Box
D 5~ Assignee(s) of Secured Party and Address(es)
II
~ 6. Check if trueQ The stamps roquited by Chapter 201, FS. have been placed on the promissory inatrumen
secured hereby, end will be placed on any additions) and similar instrument that may be so secured
~ Documentary stamps attached to original note and cmrerllyd
This statement a filed without the Oebtod signature to perfect a security interest in collateral. (Check ~ if sol
{ A{ready subject to a severity interest in another juradiction when it was brought into this state,
which is proceeds of the original colhteral descri~sd above in which a security interest was perfected:
ili Check[~if covered: []x Proceeds of Collateral are also covered[]Products of Collsteral ate slso covered Na of additional Sheets presented:
Filed with: Clerk of the Circuit court of County, F7oride
Securod Party a
(Mr..washing'ton••Does••hot..krte)
Debtor
Debtor STANDARD FORM -FORM UCC-1
* type j411 and complete corporate name
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