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HomeMy WebLinkAbout1404 4 ~ ~ - - - - - . _ _ . _ # i:S!S i1NAMCING STATEMENT h pna~wUd b a fiiny oific« for f+Wq Orrwraw~ M IM 17wiforw. Coww~rtid Code: Mobrib de» (if awr): } 1. Debbr(s) (lost Nsw~e First) o~d oddsessl~si ~ 2 S~aK~u ?arhGes) awd add+wi~ij Fx Riro Off'wr (Dub. Tiwe. lM~w~b~~. ad F~l'iny OH'ae) ~ Clantao~ ti~ar~ d~ Patrio3s 7 Gan~acal lY~oaaw Co~pa~atian ~ ~ r~ ~ ~ 801 ~tb 6th S'~r~M 3018 &?nth Fideew]. Highw~ ~t. ~nc~ c RFC n , F't. Pieec~, Fla. 3345o m ~'t. Pie~, F1a. 33~?SO ROCER POITIlJ1s eiEaK c~acwt ~~RT~ 11ECOR011ERIF1E0 4. This Fi~inY s1olt.eswl cow~s Mr ldlw~iny hP~s (or irws) w PeopMh: ~ ~ ~0 ~i ~ All ef tAe conw~~r 9oods no~ IocM~d in or obovt Ih~ pru~is~s constitutinq tl~~ J~btors' r~sidtnc~ M i rh~:r aJdr~ss obo~~ s~~ Io~rl~ o~ a~ u~r other oddr~ss b rrhich tM sm~ so~ bs r~.~d md my y~operq 4 list~db~b~. S_ As' ' ~ spnee(s) eF S~wred ~ory awd Address.~sl - , Th~ folb~.in~ yroPNh= 6. *r aw.s w~+r:~. .wa~ .p~ev.~o ~v..n e.b.. aars rs ~eiw• ~.w~•d 6r trar 10?. f~ereo sww~ N w. bw wen ~ D~.e m w v~.+~.+vv ••:.,..~.n .~ws ~.~.r?. ~ e. dvos a~. .w eeaROa .~s r.a. ..r~w. w. ~w a. w..oK.e ~ i _ - ~ This sta~enrnt is f.led ritho.rt ~i~e d~Mor's s~9~~ b periM o seawi~T' iMerest is oopolerol_ lGrtk ~y :f w'7 ~ A4eody sr~bjed ro o seani/p interesT ie onoA~er jwisditlion wMn if vws brwyhf ieb lhis sto4. _ ',.n:d~ is prooeeda of tlw oriy:nel colburol desor~ed ob~ iw ~rhid~ o searriry~ imeresd ..as per(ec4d: ~ ~ i C~.eck $'rf cover~d: ~ tron+ds of Co11eMO1 are dw cow~ed. ~?rod~cts of Cdio1~?al me olao co~rered_ No of odditiwn) Stwets ~rsseeted: r~wa .:,ti: C~.e!'~ OP 031'C1~~r tA~? ~ V~i~'~O~Ce ~O~II ~ ~ ' ~ r s,~ ti° - S:q~ohir~(s) ef Oebbr(s1 (s) ~ '~s~~~ STANDARD FORM - FORM UC~-1 C'• - _ ; ~ . ~'1 K:r, ~.~•..;i Appro~ed by 6d~ord (Oic4I STOns. Secrtbry o/ Srate. S+ot. oi Flo lda _ _ - - - - - - _ ~ z, ~ , - ~ d :IiV~, i ° ~ I 1 -