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HomeMy WebLinkAbout1407 i i . TM~s FR+AtJCUiG STwiEMENT is w•~*~ a o 6twy otfiw. i« Rliea vwswN a ~h. ~rwif«+w c.oois«da1 Ced.: Mewwwr d.4 i~ .~s1= 1. D.Wwts) (toft No.~ Fint) awd oddr.sa(~s) 2. S.ai.~d hrh~'.esl w.d eddr~ss(..) f« F•i.~y Offiar (D.~e. T~... ti..l.r..N ~i.~ Off'.o.S { Ga~wsll, Sen ~~y Ge~neza7. PYnance Cospo~at3,o~n f o~~f l 1900 Pala C3t~ Road 3018 Sl,. Federal High~ ro~~ - st Florida 9 Ft. Pie~ce, Flc~ida 33~,90 e~EMt c~u~ ta~t'r ~ uart, 334 4 RfdDRJ YE~:~~ED Th;. £waw~wq ,to~eat co..., ,A. /oMo+riny yP~s lor iAw.I w p.opw,,: ~t ~ ~ o~ : ~ All of rhs consue~r yoods ea~r IecatW :n or ebout p~~wis~s constitvtiny tl~~ I~b+ws' r~siJ~nc~ ot th~ir eddr~ss ab•e s~t lonh or ot mr o+h~r eddrss: a.hich ~he se~e ~er b~ +~we.~d mJ aqr rreP~r~~ _ list~d b~br. ~ i S- bs~r(s) ei S~wrad l+sb ad llddnss(~sl Th~ (o1b~.iM V~~P~h= 29U5'79 _ 2905rl;~ 6. e~v rcr..s esrytJ. .~o~ .yiw.:o .so..n ab.. ..a..s ww .~a.w ~w•+~ ~r owr fol. fler/. f~w.~ ~qr. rw e..~ ~iocd o~ M~ Oras+ery narvwWS rnr~d Ar~4r. od ibod aw cw/ edSbawd w/ s~rb irrr~r+ M~r ~s~ v e~cvR' TF.is sratew~M is iled wilhw~ Nr d~bbrs fiy~aArr~ b perfatt a a~ositp iMerM w oa~4oMo1. (Glr~ ~ if w) ~ . Alreodl wbject fa o ucriy en4resf ia a~oNwr Iwisd~ction wMn if .+as bro~r0~ iMO Nrs sfo4. ~ whid is procee~ of Nr oriqiwol oolbMrd des~'b~d abow i~ vrhid o s~airiqr inleres? ~ros p~nc~4d: C ~<ck $ ii to~e~td: ~ hou~Aa of CalbMOl art dw tovKed. ?~oducts ef Coii~Mrof on olso tort~d. No 01 ad6tiowol Sleeri prwM~d: . Fit~d ~.iM: ~ Q~Q~~j Q~ ~ ~ Cr6~l~81 ~9IICA ri0~'~10~'~~OII - ~ ~ dr. ~r: ' _ (s1 af Debbrlsl ~OYYw~/i STANDARD fORM - fORM tK 1 ~ , r . _L,-~ ! \ I~ ! . l~ . . ' ~ .l ~ a _ r' "i 1~•.~j Apprp~d b~ 6tl~ard (OGc!) S~Ow~. Sen~b.7 01 Sro~e. Shre eJ Flr~~ ~ ~ _ - :)=-~a~'t