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± ~ i?R61 NUMRER ~ ~~LVV
307 F L TO REOf~ER CAII (~AT LAKES BU9NESS FOf~RS dVl,
USA 1-80Q2530209 • M 1-800~358-2643 • FAX 616-243-0335 if38Wf1N WtlOi
INSTRUCTIONS: 1. PLEASE TYPE ALL tNFORMATION. and s'~yn with ball point pen. Siynature musc be legible on Filing Officer CoPies.
2. Contact Filing Otficer for tae scAedule or additionsl intormation.
STATE~OF FLORIDA FINANCING STATEMENT UNIFORM COMMERCIAI CODE - Form UCC-1, Rev. 19$ t
THIS FINANCING STATEMENT ~s presented to a f~hng oft~cer br fd~ny pursuant to the Unitorm Commercia! Code:
DEBTOR (last Name First if a Person) ~ O~~~ S~ THIS SPACE FOR USE OF FILING OFFICER
~vAM~SCHILLING ~ BRUCE C. ~ace, T~, Number, and Filing Office
,A ~~~P~~o ~ y :
MAILING AODRESS ei L~ 1 S~.
567 N.E. Solida Circle ~'~~~~K "
~ c~TV port St . Lucie STATE FL 3498 ~ v•'~X ~vi v
~ MUI.TIPLE DEBTOR (If Any) (last Name First if a Personl ~
p Qij ~Si
~ !!h 3 3~L ~
~ NAME SCHILLING, PAULETTE M.
d 1B
p ~ NiA1LING ADDRESS S
Q 5 6 7 N. E. S o 1 i da C ir c~ e R~ r s-L----- DIRON
z A.:.i r ee Bk I.tie~ CoantY
w CITY POrt St . Lucie STATE FL 3498
~ Ml1LTIPLE DEBTOR (lf Any) (Last Name First if a Perso~? D~ C T.'lz s
} NAME Iitt T8X q~..o+~ ~
~ z 1 C ~ 'f1 CLiic
; MAIIING ADDRESS T~1 = ~ ~
~ ~ I
G TY STATE
SECURED PARTY (Last Name Firzt if a Person)
; cvAM~TUPITER TEQUESTA NATIONAL BANK
2A
I MAIlING ADDRESS
! 250 Tequesta Dr. St 200
I r~TVTe uesta STATE FL 33469
MULTIP~E SECURED PARTY (lf Any) (Last Nanoe First if a Person)
NAME
[ 26
~ MAILING AODRESS AUDIT UPDATE
~
~
~ CITY STATE
~ ASSIGNEE OF SECURED PARTY (lf Any) (Last Name First if a Personl VALIDATION INFORMATION
~ NAME
~ 3
~ M,AIUNG ADORESS
i
[
s
~ CITY STATE
` 4 This F INANCING STATEMENT covers the following types or items of property (rnrlude descript~on of real proaerty on which
~ located and owner ol record when requiredl. If more sPace is required, attach additional sheets 8'/:" z 11".
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~ Schedule to UCC-1 Attached hereto ~
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~ 5 Proceeds oi co~lateral are covered as provided in Sect~ons 679.203 and 679.306, f.S. ~ No. of additionaf Sheets W
~ presented: ~
$ Filedw~th: er O t e ircu t Oll'Y"t 2
,Q
$~Check ~ 1 ? All documentary stamp taxes due and payable or to become due and peyable pursuant to Sect~on 201.22, F.S.,
have been paid. p
? Florida Documentary Stamp Tax is not required. Z
- Q
s 7~n statcmtnt Is hktl w~thoat tM C~btor's sgrotw~ to perfect a secwrtY ~ntuat ~n conataaL ICt+~ck ~f so.l ~O (Check ~ if sol W "
suu+dr wb~ect to ~ secwieY intsrest ~n anott+K ~uriW~ct~on wMn n ws WouqAt ,nto tMS state ~
or debtors 1ot~t~on chanqed to tMS sut~. Q
? wh~ch is prOCledi of tAt or~y~Nl COll~tlril dffCr~pgQ sb0`t ~n wh:Cn i ffCU~~tY ~nterest was pc~fected. ~~tw ua t~anynrtt~nq ~t~IrtY. 2
? as :o wh~ch tRe tiling Aas lapsad. ~ Moducis of tlanr~! ue covved.
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R ~CpU~I~ ifIl~ i C~7if1~[ O~ f17R1l. 1dl~1LILY, p~Da7If StryCSYI! O~ [~1!
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~ 13 Return ~
~ Copy To: NAME Patrick A. Rice , ESq. _ 12 SIGNATUREIS) OF SECURED PAR
= ADQFiESS 250 Te uesta Dr . St 2~0 OR ASSIGNEE
i R ,
CITY 'j'@gl1L' S ta x ~
STATE Florida ZIP CODE 33469 ~
~TANDARD FORM UCC-1 Approred By retary o/ Stare
Srare of Florida
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