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,I I ~ TNIS STATEMIENT is ~Nd a o filirg officw (w filiny pwwanl to IM tlwitonw Co~tinl Cod~: l. Mowr:fy doN lif onr:: ~ ~ 1. D~btor(s) llosf Na.e i'rsr) and oddress(~s) 2. S~cw~d ?wyli~a) awd oddr+s.(~s) r« ~:wa as.n. ~ K.) IlOCER ~'OITRAS BroWa~ Jemes ~ Rev ST. LUqE OOUNTY 6ANK CtERK CIaCUIt COURT 433 Means Ct. P~ a~$ RfCAR~ VEltj~~£0..~.~~ Ft. Pierce, l~lorida 33450 F'ORT PtERCE~ FIARIDiA 3 3 4 6 T 9 ZO Nn ~7 Z n,n ..r«s a«~ r~Nw s~.~«~+ e.«Nw 189565 ~a~4 fil~d wiM St _ i.t~[~{ss po1~ fibd S. ? Confimrolion. Th~ aiqial fiwanciny slaf~nt bNwww tM forpoiey Gbor and S~cw~d , b~orinY fiM ~wwb~r shorre abor~, is s1~1 ~Ff~diw. 6. ~~erminotion. S~cw~d P~1 ~~OM cloi~s o s~cwih inNi+sf ~rndw IM finadeY atsN~w bwrMY fiN rwsba showe abor~. 7. ? Auigewwnt. iM s~cw~ po+h's ri9M wdw Nr finandny abNwrM bwri~q fiM noabw showw abor~ lo rM WopM1 ~ IMiw 11 Aos b~~w msiqw~d M tM asspnN wlws~ neiM and addr~ss aPP~ is N~ 11. e. ? Anrndw»nf. F'w~ancinq S~ahiw~M bw?inY fib w~bM sl~ewe abor~ is o~nd~d as sN fatA i~ IM~ 11. 9. ? ReMase. S~cw~d Iwryr nbas~s Ilr wMoNsd d~wi6~d iw Ihw 11 iros IM fiw~riM s~ohwwM b~v~Y fiN a~rw~~r slawn abov~. • ' 10. ~CMck if trw. All doww~wl s~awp twas dw and Pof~ a 1e Mcowr du~ a~d Pes~ P~~ » 4hoW~? 301. F. S. Iww b~~w ooid. tl. tio. ef oddtiewd al~ls P~+~= ' ~VMF. WUH~ OfYW? 600u rAGE2~e~~: ~r~ S:gnowr.N) ef wsw.t:) le.u.+«r anl~ H ~r.w t is applsoaM.t. sGV~r.t+I of ?wtrli..) STANDARD fORM - FORM -3 : I~) F~a Of~io~~ Carr • A.IpIw6Nte.i Avw•••a br Tor? AcAM?s, s«..w.r ot s~a., s,aa of F~orie. _ . - - - - -