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HomeMy WebLinkAbout2804 i I i k I - i' - iM15 FIMANCINfi STATEMEM b Pnf~wNd to a fi6q afF'wr tar fiW~y P~~~ b/lr tlwifw~w Cowwrrdol Cod~: i. ~~h dm~ (if ~11: e t. Oebforls) Itos1 Mowr F'vs1) oed addr+s~(~sl I. S~wnd M1(~s) awd oddr~ss(~s) fer FiwY Of1'~ t~. Ti~e. lbwb~~, awd Fiiiw Oflice) `~tr~ ~'Aa f~'~Q'8 ~d'AZ ~HV1Q~ Ci~L'p0~'a~'rf~l FILE~ Ay~ aE~; o ~11 H 4th st.s~+st B-S- 3~18 s.Fed~aral Hi hva~y aT.~uc~r ~aup~i~r~~, ~ AacE• ,~o:r~~! Ft. rirrce, FL 33450 Ft. Pierce, FL~ ~ 33490 a~ c~c ~F ~ou~t t Thi, fiwo~:rp ,,oNwMw, osN.. Mr foilovrinY hpes (or it~w,l « D~~•M• JfW 19 y 4b 1~ ~ AI! of tht tonav~~~ yocds new locm~d in w obout ~h~ Pr~wis~s censfit~tiny th~ a~bteri r~sid~nce ot ~~ir oddr~ss obo+~ s~t fo~th o? ot mr o*~? oJ~r~ss M.I,icA ~M sa.• wer b• ..pw..d vid ey~ o.oo~~r listd b~low. - 3. Asaiyrr~(s) ef S~wr~d ?orh~ awd ~?ddrw(~s) J Th~ /olb~in~ ~?oPMp: ~ 2~39~50 ~ - ?89~50 6. Tti rar+d Yo~Y(Y. ~AO» f~o~w~lY ~s M1s~. ?Me~ 4 Or ~+~V~ rll OrO~r ]Oi. Herir LMASa N awl. Aw~ 0~^ - . obnd m ~M vor•+orr .~euw++ ~.w~d ~w.br. wd .i~ 6~ doad w~.r eid arlr www+ ~.+~r M o rc~nd_ This slelemeM is (~lyd wifhw~ Ihe d~FMOrs speehK~ b PerfM e~w'~f iwbrM in aoNeMtoi_ (CMtk ~ if so) ~~~f ~Mn b a secvriy iw/Ked iw ~ jwisdictiow wMs if vnas brwyhT iefo 11ws sfoM. 7 vrfiic# is P~oaeds of Mw xiyiwsl collaural dew~bed abor~ iw whid~ e Marrit~r i~M~rtst wos p+rf~d~d: ~ C1+ect ~ if cove~~d: ~ hon~da of Co1bMO1 ar~ elw oswred. Q?roduds of CoiloNrol o?~ olw tw~~~d. No of odditiwwl Sl+wri pnwwud: F~kA witA: Ql~'a {~I~ Q~~r WYCv F~IIAt~O~ COT~'~Cfl ' ' L~ "r~ 'C.e ~ l . G~ d?' h'. Ssy~o ) rmM~ ) SiyiwMn(s) ef D~Wwl~l STANDAR~ iORM - FORM tJCC-~ a~~~ P~GE~~ (1) Fi1~r.; Qif;~~•r f,~~y - Airhabeticai ,~.a.a br R;aq.a ca~~ s.~.. SKr~brl' of Sfvt~, s,ab ~ F;o„~ ~ i~~ _ $ ~ , ~ x`S":.. ~~x. 'y » . ~ _ . ~ - ~''t"g'~~` r'~