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HomeMy WebLinkAbout2816 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ _ , rH~s Ft?tAnCIN3 STAtEMENi b p..s.wnd a a tiW~o sff'w? f« filu"a aw*~ a N~. tMifan~ Cow~.r.dd Cad.: i_ Mohw+b dow (if wnr)j ~ t. D~b1or(sT (toM lio~r Fvsl) wd oddr+sst~a) 2. S~aw~d rorfy(i~+1 awd eddiwf~s) far Riw! Ot!'wr (Dow. Tiw~. ll~wb~r. ~d ~in~ ) - atiO~l Fr~ED n~~: w~C~R0E0 Llo~d, Et~nioe ~~Q~ Qane~ral Fin~c~ ~arP~ sr. ~uC1e ~~~Mrr Fu. 2605 l~iasissippi I~io 7~ 3018 S. F~de~al ffighw~y ~ c~E~~ic~c;~:~ `"'~'~s Ft. Pie~oe, Florirds P't. Pi~rc~, Florids 33+~?50 pFr,~::r ~_r :lE~rcouar nu: ~w s+o+..~a+ cor... M. (oMowieo ~fvK to. iwws) « p.oV••y: . rw~t ' y C~ C~ u~~~ v n y~] All el tl+• coeswN yoods no~r bcW~d in w ebout fl+t or~wis~s constitr~ino 1h~ d~bfo~i nsiMnc~ at th~ir oddr~ss abert sN forth o+ ar my od+~? edd~~ss b wl~icfi ~M sa~~ sey b~ r~sored ma any popK~y list~d Mbwr. 3. AssiqM~(s) ef S~wr~d hrh a~d Add?~s(ts) J Th~ folbwin9 yrop~rtr: . • ~ 6. r~. ..e..d w~h~r. •?.o.. s~.s~..~lO aoo~.• a.1o-.. .iei.. 4a w. .a.o. nr.~ `r oror fs~. Hv:b frww~.. H w. ~w. s..e o~oc~d w M~ Rai:Mar~ rf.~w+i rc~w~d ~w~0?. wd .ir M eMsA aw rI ~dd~~a+~ w/ "rr iwr~ir Mr w? M~o wcw~!_ Thi• atoMwMM is ~'~led ~vi1Mv1 tM d~b~or's si9~~~ b pKfM o MowHy ie/u~d iw ce~oMrol. (CMdc ~ if so) ' i = Abwdy wb~n ~o o wcoriryr intKM in ww~~r ~isdc~io~ wlrw it vws brwryAt iiMO Niis sbb. i wl~id~ if protwds oi MN oriyias) collo~uel d~W~ed abow iw viA~i~A o f~artif~ iMMtst wros p~rf~cl~d: Check ~ if towr~d: Q IracMd+ of Ce1leMol art olw eswnd. Q lroduds of CdiaMrol an olso mvw~d. No of odd'tionol Slwts pryewled: f,~.e cl~k ot cirouit oo~urt Gene~al Finanae Caorporsticn w ar. ~ `2'(/~C/~ Siq~ewn(s) d (al )R ~d ?wMli~s) STAM~ARD FORM - fORM tKC-1 ~ fl\ ~y!`.r~!Y ~f{i;^:~~' ~G7y - Alphabeticai Approtid b/ RisAvd (Di~) 51ow~. S~a~brY o1 SMN~b of F:o~ida \ 1 N - - ,j . ~.,~i 'F 2r~ i~ ~s - ; ..E SeM ~ u tY . - 'r,v=~- z ~ ~ - : ~ ~ +w'~'s., ~ ~'as ,a- . . ~ ,,:~~`??~~,~-~"'~£-~i'~,"~'~ . .~.yua-`~~'.:t: . - ~ . ~