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HomeMy WebLinkAbout0785 i . ~ 1 • . r . ~ f ~ ~ . ~ ~ , , - . - - - _ _ _ - _ - - - _ n~15 Nwurcn~IG srAtfMeiT is pieseeN.d a o til:~p otf'w.. to. ril:+p punuonr w r,. un7fam F«an»Kid Codr_ s. Mo1u~? do~. t~ ~=1 10-79 ~ 1. D~blortsl (l,o~t Nanr Fiestl ond oddr+ai~) 2. Swwd Porlri~) and addnsslesl Fw F:lirg O(fiow Tinr. Numb~t. 3ckles, Booker T. & Jewell - r^ f;T~T ~IhANG"~ ~ O1d °ffi~ , l~03-~ .N• 31st St. ~?~X 3265 Ft. Pier ae, ~l.a . ? 3t~5~ ~l ~ FEDERAL H'~'~•~~ 2~ Pi£~'.Ci:, FLORIDA 334.5~ »as iinancinp sta~la.p..r aora.s Mr followirg hw~ (w N.msl of pop~M As listed on sc~edule "A" security list dated 1C-25-7lt s. M.i~s~ts) or s«urd Per+p a,a Add~s~M~) a. n» sea~.d po.M:l, wno.. a:p~+o~nK.1s1 aon•as dor.. li~a1 th. a+omp. ..qui~.a M uwv~.. 20~• Norido Srohrl~s, if onr. Iwrs b~w~ plond m~ Piomistory insteum~eMS t~cvrad I+en~r, and witl bt pboed on onp oddt~awl and sinrlw irotrunwN d~ot mo~r b~ q swwd. This slotMnwN is 61ad withaK 1he d~bbr's sipnolurs b pKhct o MaRiIY i~N~esr i~ cottafaal. (Cl+~ck ~ if so) O N~Y s~N~ b o~u~it~ hpeest aiwMw. iu?'wi'iaion whw~ it wos brouyfa ~mo aHS ao~e. ~ VYF?ici~ is pocs~ds d rM wginol adlat~rd d~bsd obor~ in wAicA o ssaxiry imae~t wos ps~f~ded: Ch~dc ~ if ao»r~ ? Prarsds d Cofbterol oie oko ao~rered. ? Piroduds of Cdb~aol oee d~o ooverod. No. of Ad~tionol Sl+ee~s pe~senl~d: fild wid~: r~AQ.E FIPIANCE O~RP R ~ ey: Srart~d PoA~in) - Sipna~hxNs) of Deblorls) STANDARO FORM - FORNI (KG1 (l~ Fi{ing Officer G~py. Aip}ia~iaticsi ~o~d br ~ ~o~! sw~.. s«.~rory oF s+~~. S~we of Flo.ida ~ n. p~C. IOEAS NO. 1679 ; _ , ~ - . ~ ~ ~ ~ ~ r x ~ . . ~ . :s'~4~~~a~~-'~ia~`" sNa~ ..1:'_~ °