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Bar 21FL-1 Ed. Nov. '76 1 S
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STATE OF FLORIDA
UNIFORM COMMERCIAL CODE -FINANCING STATEMENT -FORM UCC - 1
THIS FINANCING STATEMENT is presented to a filing officer for filing pursuant to the Uniform Commercial Code: 3. -
t. Debtorls) ILaat Name First) and Address 2. Scoured Party srd Address * For FilirgOHicerlDste,Tane, Number,tmdFilirq
Offioel
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4. Thss financing statement covers the following typaslor itsrtnl of property: /Check box which epplles~ I
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All of the househokf furniture and jurnlshirg~ eltetnnl end acs app/lance; irrch~dirt` tele?tision
set; phonographs and record PwyeryL ?rl+lStnttor; eta, and other personal property now owned
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vv and located et the nsidencc of the Drbton at the eddnss ai?Yn abovr !n Box L
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5. Assignealsl of Secured Party and Addresslesl
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6. Check if true The stamps required by Chapter 201, F.S. have been placed on the prorriKSOry instrumen I
secured hereby. and will bs placed on any additional and similar instrument that may be so secured.
Documentary stamps attached to orislnel note and cancelled
This statement is filed without the Debtorl signature to perfect a sewrity interest in collaters4 lCheck ~ if so)
E ? Already sutrject to a stcurity interest in another juradiction when it was brought into this state.
which is proceeds of the original collateral described shove in which a security interest was perfected: -
Check x if covered: [xl Proceeds of Collateral are also coveted.~]Produca of Collateral are also covered. N0. of additional Sheets presented:
Filedwi ClerkojtheClrcultCoust County, Florida
Secured Party t -
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. Debtor
................................Debtor By Manager
STANDARD FORM -FORM UCC-1
* Typt full and complete corporate name.
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C,GI~R POITRAS
G1.fRK CIRCUI COURT
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