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• Bor 21FL-I 6d No?e '76
STATE OF FLORIDA
UNIFORM COMMERCIAL CODE -FINANCING STATEMENT -FORM UCC - 1
THIS FINANCING STATEMENT is prssertted to a filing offiosr for filing pursuant to the Uniform Commercial Code: 3
1. Debtor(s) (Last Name First) and Address Z. Severod Party and Addre~ * For Filing Off'uxr(Date, lime, Nurrlber,arxiFiling
Office!
FORBES, LIItOY, MAINE
3(55 23enetici:I Pin.~nce Lu. of iSc~n.ia '
606 I%ORIA 1141 S. t~e.irnil Hi~h~~~.~~'. i .ut 1'~~•r.-~. I'1 3 ;.1 ~0
FfT PIERCE, FL. 33450
4. This financing statement covers the folkwving typaslor itamsl of property: (Cheek box which applies)
of the household jurnitun aM jurntdri,~; electrical and ass appliance; fnchedirtg television
'ij~(
nGt; phonoarsphs and neotd plvyen~ njrj~e~ntor; eta, and other permnai property now owned
and located at the nsldence of the Debton at the addressaive» above in Sox 1.
D 5. Assignee(s) of Secured Party and Addressles)
o. Check if true x[] The stamps required by Chapter 201, F.S. have been placed on the promissory irutrumen
secured hereby, and will be placed on any additional and similar instrument that may be m secured
Documentary stamps attached to ori~lna/ note and eaneeUod
j This statement is filed without the Debtors' signature to perfect a security interest in collateral. (Check ~ if so)
Already subject to a severity interest in another jurisdiction when it was brought into this state. t
i ? which is proceeds of the original oollaterel described above in which a security interest was perfected:
' Check[~if covered: [x~ Proceeds of Collateral are also covered.[]Products of Collateral are also covered. No. of additional Sheets presented:
Filed with: Clerk of the Circuit Court of County, Florida
\ Severed Party
` 1241 S.•Fc.:rra: iii; ^h
. ~ Dabtor
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Debtor STANDARD FORM -FORM UCC-t Manager
* Type Jill and complete corporate name. .
19~ NAY 15 PN I= 29
. ~rROGER 0
~RAS~
r CLERK CIRCUIT CO
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