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BU;INESS FpRMS
iNSTRtlCTIONS' 1. PLEASE TYPE ALL lNFOAMAiqHi. ~n0 spn rnip D~p p0iret psn_ Spn~iurl rtNqf W Np~bN on Fuinp .7tfit~r CopIN. R
2- Contxt Fuinq O1fK~r ta tN sc~+~6W~ a ab0~t~o~W mtormatan. AR~EAN COOE~7~t =
STATE OF F~ORIDA '
UNIFORM COMMERCIAL CODE - FINANCINti STATEMENT - FORM UCC•1 REV. 1981 , Gj
THIS FINANCING STATEMENT is pressntsd to a tilinq offiCer for fflinp punwnt to ths Uniform Canmercial Code:
DEBTOR tW~ Nam~ FNSt il a PKSOn) TMIS SPACE Fpp V$E pf F1~tNfi OFflCEA
Nu"~E Burgess , Robert E. oau, T~m~O. Numb~r d FNmyOffiu ~
3 ~
'7U10~
7 ' ~
~IA1lINGADORESS ~~03 Palomar Avenue -
X__~~TM Ft. Pierce, FL STATE 33450 _ ~
m MULTIPLE DEBTOR Qf AHY~ {Last Nama F~n! if a Psrsonl ~ Z ~2 6
a N~E BURGESS, Theresa
~ ~8
f ;
i MAILINGADDRESS FIL{ ~i t~ _ . r
2 ?703 Palomar Avenue ROGER~~~;
o ~ ST. LUCt~ ~ . _
z _~~TM Ft Pierce, FL STATE 33450
J MUITIPLE UEBTOR (1F ANY~ (Lastldame FKSt ii s Person)
NAME
~ C ~~0~
MAIIiNG ApDRESS
~ CITtl STATE a
SECURED PAiiTY ~Last Nart+s Frst il a V~rao~+)
NA1dE Credithrift Acceptance COrp.
ZA ~
MAlIiIYG ApORESS '~s
2761 N Federal Hwy.
c~rr Stuart ~ STATE FL 33494 ~
, MUITIPIE SECURED PARTY pF AN1~ (Last Hams Firft il a PsrSOnl
~
NAME ~
2B 1
MAILING ADDRESS AliD1T ~ UPOATE ~
I
, CITY STATE
ASSfGNEE Of SECUFED PAHTY QF ANY) (Last Name F~: at ~f a Personl VAUDATiON lNFORMATtON
~ NAME
~ 3
s
~ MAiIING ADDRESS
f C~TY STATE
4. Th~~ FINAMCI?IG STATEMENT twrt~s tM lolbwmp ~yWS p ~I~ms of p!opsrty (rnUutl~ C~tcnplron O~ ~H/ AroWi1Y o~ w~~tD Iot~f~Q
end ownM of ~ecad w~~n ipu~r~d;. Ii mors spacs ~s rpu~r~d, alucn ~rtanal s?+esls Bvr' t'
Whirlpool washer New LA 55002X Ser No. C44326907 Q
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# Quasar Microwave New MQ8850 NM41688325 ~
Quasar VCR New VC5740 86043251205 ¢
Quasar Camera NeW VK744 7750293 0 3
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5. woc.eds o~ caua.u u~ cow.w a ao~b«s ~n Sactiorta 8192IX3 an0 879 308. F S. 7. No ot adCrtwna(5hsets pr~ssnted ~
a •1 v
Clerk of Court SL County o
6. FeiaC w~tn: ro M
- - - < L1 :*1
(Cneck ~ 1~Mt docums~!tary atarTW taxea 6ue and payW~a a to Wcome Oue and D+YaDte Dvnwnt to Sec~~on 261 22. F S. nave Deen pa~0.
? Fbnd~ Oocum~ntary Slsmp iu ~s not reQuired ~ ,,,~i
- - - - ~ ~0
9. Tn+s su~wr+sm ~a (a~a witnout tly debtors spnarun to prfacf s sscunty ~ntxest m cd~atxsi ICnsct~ ~ ~t sc~ (Cneck ~ if sol i U Z
airoadr suDNct to i aecur~tr intuqt in anoMer ~uriadretron when it was Droupht mto tRis at~t~ or CeOtor's ~ DeOto~ is a transmltUnq utiiity ~
N
Mc~two cnanqw to t~+a suu Prodw_~s of coi:ateni ara cov~rW
~n ~ a
wh~cA is procpdf ol tRS orlyinal cotlatsni de5cnoeA aDove i~ w~k~ s s~cur~ty mterest wss p~rf~cts0. N~
~
r~s to wn~cn tM i~unq nn IapsW
~ SIGNATURE(5) OF DEBTOfyS~
~ aepu,rr7 alter a ehanqe ot name, edantny. a ewporate s!~uuure ot tna
~ A~DtOr Ot ~ S~CUrlC pirty.
~ 3. Retum copY to. --i
NAME -
• ADOIiE55 SiGNATURE(5) OF SEGUR
PARTV(IES? OR ASS! NEE ~
G~TY
• Ct~.
STATE Z~C CO
STANDARD FORM - FORM UCG t ADC'cre0 by Srre~ary o~ S~a!e S+ase o~ ~~c~.oa
rt~ ci~ ~n~r r~Fc~r.~H r.OPY
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