STATE OF FLORIDA UNIFORM COMMERCIAL CODE FINANCING STATEMENT FORM ­ ADDITIONAL PARTY 16. INITIAL FINANCING STATEMENT FILE # (same as item 1a on Amendment form) 17. NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT 17a. ORGANIZATION'S NAME 17b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 18. MISCELLANEOUS: 19. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME ­ INSERT ONLY ONE DEBTOR NAME (19a OR 19b) ­ Do Not Abbreviate or Combine Names 19.a ORGANIZATION'S NAME 19.b INDIVIDUAL'S SURNAME 19.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 20. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME ­ INSERT ONLY ONE DEBTOR NAME (20a OR 20b) ­ Do Not Abbreviate or Combine Names 20.a ORGANIZATION'S NAME 20.b INDIVIDUAL'S SURNAME 20.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 21. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME ­ INSERT ONLY ONE DEBTOR NAME (21a OR 21b) ­ Do Not Abbreviate or Combine Names 21.a ORGANIZATION'S NAME 21.b INDIVIDUAL'S SURNAME 21.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 22. ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME ­ INSERT ONLY ONE SECURED PARTY (22a OR 22b) 22.a ORGANIZATION'S NAME 22.b INDIVIDUAL'S SURNAME 22.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 23. ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME ­ INSERT ONLY ONE SECURED PARTY (23a OR 23b) 23.a ORGANIZATION'S NAME 23.b INDIVIDUAL'S SURNAME 23.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 STANDARD FORM - FORM UCC-3 AMENDMENT ADDITIONAL PARTY (REV.05/2013) Filing Office Copy Approved by the Secretary of State, State of Florida American LegalNet, Inc. www.FormsWorkFlow.com