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~y~q~ 1 VLEASE TVPE ALl IHfORMATIOH. 7y+0 a~p~ +~t~ Oa11 pan~ p~n Sqnatur~s mua~ De ~~p~D~s on i~~infl Otl~ce~ Cop~ss
2. f~11 ~n orp~nal F~nanC~np StatMnMt numON arW Aat~ IJ~O (~n It~rn W1o+r) ~
3 ConIK1 fd~np Oll~cer for tee scnaAuN or sdG~tanal ~nlormatw~+ 's
Seminole Form UCC-3 ~
STATE OF FLORIDA
UNIFORM COMMERCIAL CODE - STATEMENT OF CHANGE - FORM UCC•3 REd. 1981 s~
THIS FiNANCINQ STATEMENT Is pns~nt~d to a Nlltq offkw la Nlinp pur~wnt lo tM Unllam Comn~clal Cod~: ~
Mlormatbn in rt~ms ~ and Y musl ap:~s eaacUy wrtn tne aq~~ ~~~~~9 ~^~~'^'~~'O^ a THIS SPACE FOR USE OF FIUNG OFfICER ~
~~w1O1_'~Y ~^~d _ OaH. Txna. NumOe~ 8 fd~np Olf~ce ~
DEBTOR l t Nam~ F- t d s Per ) - - ~
HAME A. 10 210 31 r
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'A MA~LING ADDRESS 1900 Old Uiaie H1~W`dy s'. : SW ~QUGIr~S DIXON
cirr Fort Piel~c~e STATE ~'1o2'ida 3345U " s St Lt:c;c Counh~ ~
x llu.; 1'ar 3 Clerk ot '~rcait Coud
~ MULTIPLE DEBTOR I~F ANV~ ~Last Name F~rst ~1 a Qerwn~ ~
¢ HAME int 1~il:i S~ By
~ / Deputy Clerk
< • e Tctal = .l~.~.~ -
Z MAIIING ADORESS
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J Gry STATE •7U ~lllM Al l~~
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~ MULTIPLE OEBTOR pF ANV~ (~ast Name F~rsi a Prwnl
NAME 10 210 31 a
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,c .;r~~,~r,~ A ; ~ ~,.t. .
MAI~ING ADDRESS _
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Gr/ STATE f
SrcCUREO PARTY (Last Name F~rst ~t a Pe~sonl UPDATE
H,we Connecticut General Life Insurance Gb. ~
2A c/o CI(~TA C,apital Advi~ers, Inc. !
MAILlHG ADDRESS ~7".~w AUDIT
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GTY ~fOTd~ STATE ~~SG
NULTIPLE SECUREO PARTY ilf ANYI ILast Natne Fi~st ~f a Ps~sonl yA~IDATfON INFORMATION
NAME
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MAILING ADDRESS
G~y STATE
3. TMS atatlmsM rolerS to oripmil F~n~nan0 Stitem~nt Wannp fds Numper '~~((~C~i ~ R~__~767 ~jpp `WV anOhlW~vith
Clerk of Circuit Caurt S~ iil(•iP rnmtv FI_ TASwp~nalwslhls0o~ `t~,.nt+nr 2'1 19R
4_ ? Conunwtion T~e w~p~~ I~nanunp statement Gtws~n tM tapomy DeDrorlel u+d ~urW Part~~ql Wannq fds numper snown ~bors. ~s shu alfecuve
; 5. Term~natwn Securea partr no ~onper ua~ms a sscun~r ~nterast unosr ene hnanunp sutsment b~u~nfl t~it ~umDe~ snown aDOVe
6. Partyl Some ot SecureG pa.ty's r~pnts urWer tns F,na~a~q Ssatemem nare bsen aasp~ed ro me asspnee wnose name and address are xt iortn ~r:
1 Asspnment Item t1 A Oexr~9hon ot tne conaTera~ suD~ec~ to tne ass~qnmen~ ~s aiw set fort~ ~n ~tem 7~
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t full All ol Sec~re0 Partys nynts ~~+Oer the F~n,ncmq Statemem nave Deen ass}pned to 1he ass~ynee whose name an0 a~dress are set ~.xtn
€ ilu+pnment in Item tt
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3 8, AmenQment Finan:.mq Sl~tement Deannp ble num0er shawn aDOVe ~s amende0 as set IortR ~n Item t t S~yrtature ol pe0ror repu~red at Item U unbss
~ f amendment cAanqes only name or a0dress o~ e~tner party #
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~ 9. ~ Re~eax Securea psny reteases a~~y tne conaten~ aesu~~eo ~n nem t t trom tne hnanc:Rq statement beannq Ide numDer shown above
~ Cl Cneck ~1 true Afl Occumenlary stamp ta:es Aue arW DayaDle w ro Decome due arxf payaWe pu~swnt to Gnapler 2pt 22, f S nave been paW
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~ i 1. it mwe space ~s revu~~eo, attxn addmonai sneets B'n
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~ ~ Z. No o~ Add.uonal Shee13 ~4. SIGNATUREISI OF DEBTOWS? t~qae5sary O+~fy For
presenteA Amendment Se! Item 8 -
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13. pa~urn Copr ~o - . .
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= NAME -1~Ya a~ II~..
ADDFiE55 P~ Q~ ~g ~ ~~J. SIGNATUR~($) OF $ECUREO PARiYpES~ OH ASSfC1~lEE
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STATE FL~II~ Zfo ~ppE >p~ ~ Cr~; ~
I .aroai~ ~~Q~~ ' s t et~
~ ~TANDARD FORM - FORM UCC•3 /?oorotidDySeu~qrydSut~,Stat olFbn7a
~ FILING O~FICER COPY
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