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ROGt~ ?O~~RAS (
CIERK C;.;(,U~T COURT
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Affidavit Under Fictitious Name Statute
STATE OF FLORIDA -
SS.
COUNTY OF ST. UKIE
The undersigned, under oath, says: That he or she is engaged in a business enterprise under the
fictitious name of ___________~YNE CLINIC FOR CHILDREN -
3015 Oleander Ave.
located af - - - ' .
Ft.Pierce
in the City of St. Lucie County, Florida
Those interested in said enterprise, and the extent of the interest of each, is as follows:
Dr. Richard F Kaine 100 %
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Proof of publication of this intention to register, is filed herewith, pursuant to the provisions of
Chapter 20953, Laws of 1941.
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----Signed: ~ ~ -
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Sworn to and subscribed before me this _ / da of ' ,
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ROGER POITRAS - - - ~~~~y,'`L:e~~.' -
tLfRK CIRCUlT COURT Notary PJ~SIic ; ;
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MY Commiss+on Expires Oc~d~et"1~~~`1911
BY D.C. My Commission expires------------------ ;
800~223 P~E1i73
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