STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT FORM A. NAME & DAYTIME PHONE NUMBER OF CONTACT PERSON B. Email Address C. SEND ACKNOWLEDGEMENT TO: Name Address Address City/State/Zip THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1. DEBTOR'S EXACT FULL LEGAL NAME ­ INSERT ONLY ONE DEBTOR NAME (1a OR 1b) ­ Do Not Abbreviate or Combine Names 1.a ORGANIZATION'S NAME 1.b INDIVIDUAL'S SURNAME 1.c MAILING ADDRESS Line One MAILING ADDRESS Line Two CITY FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) This space not available. STATE POSTAL CODE COUNTRY SUFFIX 2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME ­ INSERT ONLY ONE DEBTOR NAME (2a OR 2b) ­ Do Not Abbreviate or Combine Names 2.a ORGANIZATION'S NAME 2.b INDIVIDUAL'S SURNAME 2.c MAILING ADDRESS Line One MAILING ADDRESS Line Two CITY FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) This space not available. STATE POSTAL CODE COUNTRY SUFFIX 3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S/P) ­ INSERT ONLY ONE SECURED PARTY (3a OR 3b) 3.a ORGANIZATION'S NAME 3.b INDIVIDUAL'S SURNAME 3.c MAILING ADDRESS Line One MAILING ADDRESS Line Two CITY FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) This space not available. STATE POSTAL CODE COUNTRY SUFFIX 4. This FINANCING STATEMENT covers the following collateral: 5. ALTERNATE DESIGNATION (if applicable) LESSEE/LESSOR AG LIEN CONSIGNEE/CONSIGNOR NON-UCC FILING BAILEE/BAILOR SELLER/BUYER 6. Florida DOCUMENTARY STAMP TAX ­ YOU ARE REQUIRED TO CHECK EXACTLY ONE BOX All documentary stamps due and payable or to become due and payable pursuant to s. 201.22 F.S., have been paid. Florida Documentary Stamp Tax is not required. 7. OPTIONAL FILER REFERENCE DATA STANDARD FORM - FORM UCC-1 (REV.05/2013) Filing Office Copy Approved by the Secretary of State, State of Florida American LegalNet, Inc. www.FormsWorkFlow.com Instructions for State of Florida UCC Financing Statement Form (Form UCC-1) Please type or laser-print this form. Be sure it is completely legible. Read all instructions on form. Forms must be completed according to Florida state law. Fill in form very carefully. If you have questions, consult your attorney. Filing office cannot give legal advice. Processing fees are set by the Florida Legislature, are non-refundable, and are subject to change. To verify processing fees, contact FLORIDAUCC, LLC. at (850) 222-8526 or email help@floridaucc.com. Make checks payable to FLORIDAUCC, LLC. or the Florida Department of State. Send ONE copy of each filing request, with the appropriate non-refundable processing fee to: Overnight Courier Service 1st Class Mail FLORIDAUCC, LLC. FLORIDAUCC, LLC. PO Box 5588 2002 Old St. Augustine Rd. Bldg. D Tallahassee, FL 32314 Tallahassee, FL 32301 The acknowledgement copy will be returned to the address indicated in block B. Do not insert anything in the open space in the upper right hand portion of this form; it is reserved for filing office use. If you need to use attachments, you are encouraged to use the State of Florida Uniform Commercial Code Financing Statement Form ­ Addendum and/or the State of Florida Uniform Commercial Code Financing Statement Form - Additional Party and/or the State of Florida Uniform Commercial Code Financing Statement Form ­ Additional Information. American LegalNet, Inc. www.FormsWorkFlow.com