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, ~ . '~~S FINANCtNG STAiEMENT ~s D~es~ni~d to o fitiny oHicer ~o. f.t~n0 punuanf b efi* Untio~m Comm~rnd Cod~. Mah+r~h do~~ {N anr1~ i _ ~ ' 0~6~or(s) (lasf Nom~ Flrstl ond o3d~~ssl~t! Z- S~cw~d Por?*{~~s) a~A oddr~ss(~sl For F~I~nq Offic~r (Do~~. i~m~. N~mb~r, ond F~I~ng OKK~1 ! '~febb, So3om~n I:FC ~lE0 ANO REC~~~E~ ' 807 N 23rd 3t . P 0 Box 219 a?.~uciE couK t~~ ' j 3 ROGER POITRAf ~ Ft Pie rce ~t P ierce CIERK CIRCUIT COURt'~ ~ RECORO VERtF~ED.....~.~• i e Thls Neoncfnq sfol~m~ne co.~ri tb~ lo~lo.roq eyp~s (or a~msl a( proD~.r~~ M~ 8 11 ~ S'3 ~rv [ "All Cc7st~mer JO~~.IStt I S Asflpn~~{tld5~car~dDprqondAdd~~~sl~s) ~ 3 t ~ ; 265412 2#~S ~12 ' _ { C CA~cI M trw ~ ih~ s~ow~ps .~ou~r~d sy ChoP~~• 201. F.S. ho.~ b~~n ploc~d o~ fh~ Dromisforr ieflrVm~nif s~:vr~d i i h~r~py, and ~ill b~ pbt~d oe on~ oddit:oeol o~+Q s~mNo. ~nsrrom~~r Mot mo~ b~ io ~~cu~~d. - Ihis s~ot~m~nt i~ fil~d ..~Movt M~ d~abi + spnon+r~ a puf~U o i~cu.a~ ~et~r~~~ ~n collof~rol. lCh~ck QX .1 sol _ ?~6wdr wb~•a a o s«~.ar ~nbr~sl in oeOlh~r (w+sdKripi ~.h~n u..o~ brovQAt ~nb d~ls srofs- ?..I+.d+ B p.oc~~ds d M+~ o~p~nol colto~~.ol d~scr~b~d obo.~ ~n .~A~cA o s~c~.+ry ~n~~r~s~ ..oi P~rfec~~d _h~ck ~ if cowr~d~ Q~ p.u~~ds of Coilm~.al ar~ olso m.~r~d. ? Prodvc~s ol Cot~a~.ot m~ olso co•~~~d. No 01 oAd~uo~e~ She~rs v~es~~r~d d Fil~d with: i : ~ .,i~-- / ~ ~ _ 6Q~ 2~.9 P~~~3~3 -rl~'? ti . ~ _ B~ ~ , • B ~ ` , f ~ Sqnarw~(s) ~ O~ba.l+1 SpnaWr~tsi d S~cu~~d Go~typ~si ~ , STANDARD FOAM - FOltM UCC-1 _ •pp.o.~d b~ TOM ai:M~tS. Se:,...., d Ftu~do ! , . ` - . . . ~ - ; _ _ - ; < . . .rs