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UNIFORM CWNMERCIAL .CODE - FINANCINQ~ STATEMENT
Nse ONLY foc recof+dirlg in offices of perks of the Cirwit Court -NOT for filing with the Seuetsry of Stale.)
INSTRUCTIONS:
1. TYPE- ALL INFORMATION, using a typewriter havirp a good ribbon, AND ACCURATELY TYPE THE NAME BELOW EACH
SIGNATURE.
2. 8a wro to fill in All numbered spaces which aro applicable. .
3. If any space is not largs.enough, type therein "See alt sheet(sr'. (The sine should b~ 8K" x 14" or smaller.)
4. If collateral b farm. products, or goods which are or sro to bsoorne fixtures, typo in specs No. 4 a description of the real
estate which "reasonably identifies what b described", and give Hams of record owner.
5. SEND ORKiINAI OF EACH PAGE TO THE CLERK'S OFFICE to bs rocorded and returned. IF you aro paying an additional fee
for having recording information noted on a Dopy, also send a legible carbon copy of the first paps.
6. 8E SURE TO CHECK ONE OF THE TWO STATEMENTS UNDER NO. B BELOW.
This It1NANpNO STATEMENT b prosented to a Clerk of .The Circuit Court
for Recording pursuant to tlls Uniform Commercial Cods.
` 1. oebtotW Nen»(s) and Addreu(es) Mast name Mt) 2. S.ourai (~.rty(l.a) and I?dtir.eKs) This spap for Clwk'a use ONLY
Ft. Pierce Care Center, Inc. ComBank/winter Park
c/o Florida Living Care,Inc. P. O. Box 1420
P.O. Box 815 Winter Park, FL 32790
Altamonte Springs, FL 32701
A ~ -This Stetertwtt coven the folbrrirg type (ar itam~ of PERSONAL PAOPfRTY, FIXTURES, ar FARM PRODUCTS.
N
~ See Schedule A attached hereto and by this
~ a reference made a part. hereof
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4. A description of tM rwl estaee which °raasonably dentifies wMt is described" and tM Hama of the owner of
tM real p?oparty.
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~ Owner: Fort Pierce Care Center, Inc.
Legal: See Schedule A attached hereto
5. Maturity da?e Cd arty) a tYumbar of sMNS a
7, /lssipnee(s) of Secured Party(ies) and Address(es) y
e. ONE OR THE OTHER OF THESE TWO STATEAAENiS MUST t3E CHECKED. (01Mrwise it a not racordableJ ~
CMck if true: ~ iM stamps r.quired by Chapter 201, F.S. have bean placed on tM prarnissary irgtrwttents
secwed Mreby, and wig be placid on arty add~tiorwl promissory trtstrurttartts, advances a
similar instrwrtent that may b~ so sen+red. ~ .~I'
Check if trw: ? Stamps are not required by Chapter 201. F.S. ~~J~
9. if this statement is recorded without tM Debtors sipnatae to perfect • severity imerest in collateral, dwd: one of tM foUowirg: +l„r.•"
? Collateral wss subject to • security imereq in anotMr juris~ction wMn it was broupln irMO this slate.
? Cdlateral is proceeds of tM original collateral described above &t which a severity interest was perfected.
10. Check if trwC ~Prooseds of Collateral an also oonered. ? Products of Collateral an abo covered.
ll. Filed wiMa: Clerk of the Court, St. Lucie County, Florida
_ ~`~e C nter Inc. Co /Winter Park
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. t?~, y~j~~: .'ttalow each signature) gyp. rtante below tyre)
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~ $lerk fo? recor~np.)
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