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Affidavit Undei Fictitious Name Statute
STATE Of RORtDA
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The unde~signed, under oath, sbys: That he or she is sngaged in a busin~s enterprise under the 4
fictitious name of L~~+~ C-G
located at !~--~~~----~!.~~--~~r~--- ~~1~G~--------------------------------
in the City of __~~R~ ST L~C~F St. Lucie County, Florida
Those inte~ested in said enterprise, and the extent of the interest of each, is as follows:
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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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Sworn to and subscribed before me this ---l---~~= day of 19_~-G
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ROGER POITRAS t~
~ ota Public
~ CLERK CIRCUIT COURT
l~ptAR1f pUet1C STAf! O~ H.ORtDA AT UR~3!
~ . MY COMA11S5lOl1 EXPfRES IAN. 20. 197$
~pNOEO iHRU GENERAI tNSURANCE UN~.RWRSTER~
~ ,C. My Commission expires_ ~
BY fll€~0 ~-k6kEC~R1~Eff
ST.IUClE COUNTY LA. _
ROCER ~O~T~AS
CIERK C9:.CU1T COURT
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