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Bon 21FL-1 Ed. Nov '76
5U'1211
STATE OF FLORIDA
UNIFORM COMMERCIAL CODE -FINANCING STATEMENT -FORM UCC - 1
THIS FINANCING STATEMENT is presented to • filing officer for filing putwant to the Uniform Commercial Code: 3.
1. Debtorls) (Last Ntane First) and Address 2. Seared Party artd Address * For Filing ON'tcer(Dste, Time, NumMr,and Filing
Office)
~91D ~~N 10-th. SY'• t~».~ .
F c~T 'P,r RC.k F 1141
~ 33 ~ISD
a. Th fis:ancin~stat=ssxnt coxets th~i fo1~nQ typeslor itamsl of property: /Check box which opp/lrs/ ~
All of the housthoW jurniturr and jrrnishi?g; electrical and gas applancr; lncludiraj television -
set; phonographs and record prayer; rojr/geratort, eta, and other personal property now ownr+d
and located at the ntrdenn of the Drbtort at the oddness given above in Box 1.
ra Assigneelsi of Secured Party and Addressles) -
~ 6. Check if true The stamps required by Chapter 201, FS. have been placed on the promissory instrument
~ seared hereby, and will be placed on any additional and similar instrument that may be so secured.
[Documentary stamps attached to original note and canccArd.
This statement is filed without the pebtors signature to perfect a searity interest in collateral. (Check ~ if sol
Already subject to • saarity interest in another jurisdiction when it was brought into this state.
which is proceeds of the original collateral described above in which a security interest was perfected=
Check x if covered: [x~ Proceeds of Collateral are also covered.(]Products of Collateral are also covered. No. of additional Sheets presented:
F ~ led with• Clerk of the Circuit Court of Caen ry, Florida
~ Seared Party •
~~ior
By .........................................................................~~~r... -
................................~t« .
STANDARD FORM -FORM UCC-1
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* Typt /ir/1 and complete corporate name.
- SU1:211
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190 SEP 29 P!I I~ 36
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• 51.LUCtE C6J)I1Y.FlA.
ROGER f
0)TRAS
CLERK CIRCUIT//C ~tJRT -
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