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228053 ~
Affidavit Under Fictitious Name Statute
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The undersigned, under oath, says: ?hat he or she is engaged in a businsss enterprise under the
fictitious name of ____~.__CHARLES CHIPS OF INDIAN RIVER
located at _ lOb _North _lltt~_~~~'~~~
Fort Pierce St. lucie Covhty, Florids
in the Ci of
Those interested in said enterprise, and the extent of the inte~est of each, is as follows:
CHARLES R. CARLISLE 100$ '
- Proof of publication o~f fhis intention to register, is filed herewith, pursuant to the provisior~s of ~
Chapter 20953, laws of 1941.
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Sworn to and subsaibed befare me this day of ______APril 1972__.
ROGER POITRAS .
CLERK CIRCUR COURT Notary iic
BY D.C. My Commission expires__~ 752---
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