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O~ FLORIDA
~Q~ 0~ ST. LUCIS
~~reby ~tify, That on rhis day, 6ejore me, an o~''icer duly authorised ia the Stute a/ore• ~
said and in the County ajoresaid to take ackn~~wledgmercts, personally appeared ~
DANIffi. COS.LIS, a einqle adult, ~
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to me known to be the persc~n ~lescri6ed in and who executed tlee /oregoing it~strument and
he Qckrwwledged be~ore me that he executed the same. i
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my hand ctnd o
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fecial sea! in the Couqty and State last a/oresaid this '
dayof. :=:~~~cember A. D. l9 67 . -
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FILED AND RECOROEO ~ i
ST. ~UCIE COUNTY. FLA .
R;:COR~ VERIFlED ,
'67 OEC 29 PM I :4q ,
:;v~~?~ ~o,~,~;.s -~~31i1 t
'CLERK-CIRCUIT COURT ?
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