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Affidavit Under Fictitious Name Statute
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STATE OF FIORIDA '
SS.
couHn of sT. wciE 3~~29
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The undersigned, under oath, says: That he or she is engaged in a business enterprise under the ~
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fiditious name of ___________KA 1 NE CL 1 N 1 C '
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3015 OLEANDER BIVD.
located at
FORT PIERCE~ FLORI~A
in the City of St. Lucie Cou~ty, Florida
Those intereated in said enterprise, and the extent of the interest of each, is as follows:
RICHARD KAINE~ M. D. 100~0
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Proof of publication of this intention to register, is filed herewith, pursuant to the provisions of £
! Chapter 20953, Laws of 1941. '
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° Swom to and subscribed before me this ~
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ROGER POITRAS
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= CLERK CIRCUIT COURT Notary Public
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# BY -_„f-r!_~ s~ Zs_~ ~--l
~--~L l`=- D.C. My Commission expires----`=--_------
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