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STATE OF FLORIDA
aa.os UNIFORM COMMERCIAL CODE -FINANCING STATEMENT -FORM UCC - ~ .,,r••
~•+T forms used for filmy vrith the Office o1 Secretary of State pursuant to the Uniform Commercial Code tyttrst Ot approxd by Toth Adams; Secretary of State, State of Florida. t/J
INSTIVCTICMtS: T
1. PLEASE TYPE this form. Fold only Bony pesforotion for moiling. ]OS13
~ 2. Restore Secwed Paty and Debtor copies and send other 3 coptes wtth rnterleered carbon paper to-the filing offices. Enclose Frlrrtg fee of 13.00.
4 ~ 3. If the space Drovtdcd for any item(s) on the Form is inadequate the items} should be continued on additia-tol shcN>, preferably 5". E!" err 2". 10" Only one -opy of
such add~nonol sheers need be preserved to the filing oll:cer with the kra three copies of the hnoncing sraternenr. L~.rq schedules of colloreral, ,ndentvres. etc..
may Ix on any s~:e paper rhos is conrcntrnt for the secured Daty. Indicate me n.,enber of oddthonol sheets ottocF:ed. Enclosr hl,ng lee of 11. JO for each .tddrhonol shee+.
i 1. If coltmerol is crops or goods which ore a are. to become fieNres. give the le,d description of the reel ,store a+d note of record ovrner a record lessee.
S. 1Yhen o copy of the sccwiry agreement is uxd os o financing statement, it is requested fbM it be ecconportitd by o completed but unsigned xt d these
Irre~s_ An rsddirionol lee of 12.00 is required.
6. Please sign this form rtrh a boll point pen. $igriaures must be feyible on olphobeticol and numerical copies.
7. IF Filmy with Clerk of Cirwit Covet cmwlt Chapter 2ft, F. 5.. a local clerk lo. proper fees. '
THIS FINANCING STATEMENT is pesented M a filirq elficer For filing pwsuont b Nr Unifarw Carrne+ciol Coup: 3. Matrriy rlaN (if any):
1. Dttbter(s) (lost Hare fist) end address(es) Secwed ?arty(ies) and otfdress(es) res. ra:w~ pttiw +ure. rte, tav.ite., awl raiy OAirel
Virgin, Vernita J. FLORIDA BANK AT FORT PIERCE ~42SZ
3107 AVe. G P. O. BOX 3469 Ja,o (~j 22
Ft. Pierce, Fl. 33450 5o i owwcE AvENUE ~ ~ 9
_ FORT PIERCE, FLORIDA 33450 ffifp t~~Fs
- SLIM~ Ea` 0
ppn~e..r~w.TR S~
s. Tbis firoerirp srosersertt corers 11sr folbwirty typal (or ilerws) of propertp: - •r<gCIT
Florf.da Docwnentary Stamps have been attached- to Orig' a~ a.EiRltt~leq~~~rR
=1RD YERITtt~_ _
N~oefa, Chair, Rocker, Otto Tabie, it 2 End Tables, s. Asaiyrree(e) aF s.atr..a.ery ens Address(es)
Chest, Double Dresser, Head'Board "Full",Nite Stan ,
I Mirror, King Site Bed, Frame ~ Bedding _
4 Dinning Room Chairs ~~~1 '
6. Tit sscved porly(s), wltaee sgtotvels) appears 6eb.. fares rbrl t4 reetps ieq..ad by Cltoter Tol. Fbrrdo Ssae.tu. i sty, low bean
ttloced a t1r prartriratty wrrtwetrs secwad lerebr. and a b! pbced at arty at)drroed reed s+tr6r wlremrM tLar soy be n roved.
This sbtwrtt b (fled withaA dto drrbters sigrtetwr b pttAM a security interest iw cotbNrd. (Check ~,•if sa)
p ? Akwdy tubjoct a a seatrAy inNrrtN is onothw iwis6tfiaer whwt it wes brrtstpht inio Ntis statN.
? whidss proceeds of Nse eripinol ceNoNral dtsw:bed oboes in which a security intesrxt woes perfecNd:
Chest ®R coca Ireceeds of Cellorwel ore dse cerered. frerfucq o/ Ce1loNrel era atse cererpd. No. of odditiond Slreeb presented:
filyd wit": Clerk of Circuit Court St Lucie Count
Flo ides Ba A art Pie
!r: ~~t.F.~~ fi. _ ~~_r~~..._ far:
~ SiswoNro(s) Orbtw(s) Siyrohrr ) Iasipp~~
sT~o~uD ~ - I<oRM ucc-~ 1 t~6E 00~
Apprrsred by Tow Adams, Secretory o1 Stota, Slots of flwido