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. 5041~'~
ua Fttrtt? *ISi-Raordec from hula Irintirta Co., d4ndo, Florida J28ot--ens»s
o 198a-h..n ca STATi OF FLORIDA
UNIFORM COMMERCIAL CODE -FINANCING STATEMENT -
Nse ONLY for recording in offices of Clerks of the Circuit Court -NOT for filing with the Secretary of State.)
INSTRUCTIONS:
1. TYPE Atl INFORMATION, using a typowriter having a good ribbon, AND ACCURATELY TYPE THE NAME BELOW EACH I
SIGNATURE.
2. Be sure ro fill in All numbered spaces which are applicable.
3. If any space is not large enough, type therein "See attached sheet(s)". (The size should be 8y4" x 14" or smaller.)
4. If collateral is farm products, or goods which are or are to become fixtures, type in space No. 4 a description of the real
estate which "reasonably identifies what is described", and give name of record owner.
S. SEND ORIGINAL OF EACH PAGE fi0 THE CLERK'S OFFICE to be recorded and returned. IF you era paying an additional fee
for having recording information rested on a copy, also send a legible carbon copy of the first page.
6. BE SURE TO CHECK ONE OF THE TWO STATEMENTS UNDER NO. 8 BELOW.
Tfiis FINANCING STATEMENT is presented to a Clerk of The Circuit Court
for Recording pursuant to the Uniform Commercial Code.
1. Debtor(s) Name(s) and Address(es) (last name first) 2. Secwed Party(ies) and AddresKas) - Thin apace for Clark's use ONLY
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Nichols, John D. The Mutual Life Insuranc
1256 Old ?rail Road Company of New York
Maumee, Ohio 43537 Broadway at 55th Street j
_ New York, N. Y. 10019 r
3. This Statement coven tfie following typos (or items) of PERSONAL PROPERTY, fIXTURES, or FARM PRODI)CTS.
See Exhibit "A" which is attached hereto and
by this reference made apart hereof. -
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a. A description of tht real estate which "reasonably identifies what is dexribed" and the name of tln owner of
the rte) proparry.
See said Exhibit "A" -
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~ OWNER: Debtor {
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5. Matwity date Gf anY) 6. Number of sheets att 1
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7. Auignea(s) of Secured Party(ies) and Address(es) S : ` = : - • . _
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8. ONE OR THE OTHER OF THESE TWO STATEMENTS MUST FiE CHECKED. (Otherwiss it is not recordable.)
Check if true: The stamps required by CMptcr 201, F.S. Mw been pboed on the .promissory instruments ~ • - • ~ ~ _ j
secured hereby, and will be pbced on any additional promissory irstruments, advances or C;' L ~ ~ _ h !iii
similar instrument that may be so secwed. i
Check if true: ? Stamps are-not required by Chapter 201, F.S.
9. If thin statement is recorded without the Debtor's signatwe to perfect a ascwity interest in collateral, chock one of the following:
? Collateral was subject to a security interest in another jurisdiction when it was brought into this stals• 11
? Cdlaterd is proceeds of the original cdlatsral described above in which • security interest was perfadsd.
10. Chedi if true; ®Proueds of Cdlateral are also covered. ? Producri of Cdlataal are abo covsred.
Filed with: Clerk of Circuit Court, St. Lucie County, .Florida
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THE MUTUAL LIFE INSURANCE: COMPANY
OF NEW YORK
~ BY• AND ON S U~H, Attorneys
lay= ay: \ J~Q G~--
/ Sgrtatwata/ of Otbtor(s) Siprntun(a) of Severed Party(iea) '
/ tiyp. rwtw below eadt aignatun)
John D choi~"'""•)
(l) Original (To be sem ro ~ or recordings -
' - - 6000~K~ PIfE ~.U
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