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HomeMy WebLinkAbout0272 j . f ~ ~ ~ ~ E ~ ~ INANCtNG STATEA~IBJT is b a fif officsr fw fil" b Iht Unifpm Conrnertiol God~_ 3. dot~ (if w.~+»a ww vw~m ~.ar ~r.~ 9/80 ~ s) nost Nore~e Fint) ae,d add~essla) s_ s«w.a Pb~t~lie.) w,a adaw.y{.s) ~ ~O. F~~ie~ ~aff,d F~in~offio) ~ r~lu+nbe.~ Baker, :iezekiah A- sladys . T"' ' : ~ 19t~°, Barcelona Av. r , . " ; • ~ . Ft. Pi~rce, ~la. 3?`~5~ ; , - , -<< t.- ~ Z . . , . 3~ . ~ ~ . . . . - ~ 7601 ~ s. Tha financiny swlenwM coren N+e ~ollowie9 h~P~~ (a ~~+s) of Wopa~AN i t y _1s listed on sched~le "A" security list dated 9-1?-?5 ~ ~ s. Asagn..l.) or s.~w.a Pbr+p a,a Aad~p.i••) ~ a . ~ ~ ~ ~ b. n,e .«u~.d ponytst. who,. siqnotu..1~) oPP~s belorv. s~oMS 11wr x» sbTpa nquie~d br Uwv1e? 201. ~ Fbrido S~oprles. if ony. have baen plootd on tlw ptomissory wWrunrnts sKw~d henby, wd will b~ ~ Pboed on anr odditiorwl ord sinubr iestrwnseN Nwf mop b~ os s~evhd. ~ This slot~maM is fild witlq~il tM dsbbr's siqrwMt b pKhd o s~oi?rilp ieN~e~sf in tollm~srol. (Chstk ~ if so) O N~~od~ M+bN~+ b a sscv^h ~nrerest a, aw~he. juradic~~on wlnn e wos b.apht iMO ~his swk. ~ ? NAtich is prooe~ds o! 1M otiqinol oolbterol deuribed obo~rt in whid~ o secwilr intentt wos perf~cNd: ~ Chedc ~ if owend: ? Procseds of Colloterol an oho ewe~d. ? Products of Collotnol ore d~o eovercd. No. of Additional Sh~e~t presented: ; ~ Fibd wilb: ~ i ~ ~ ' - ~-".E`~i..~~ ~ ~ ':AGI.: ?L':r'ItJCE CO?.P ~ ~ ~ - ey: h= ~ Sipiwtw~ls) d Debiorts) Siprwlwetsl oi S.cvred nr1+s) STANDARD fORM - fORM HCGI - Filir.g Officcr Co~y . Alnh~beticeE Mw~ br ~cd+o~a ~o~t sw~.. s.u~,ory o~ s~o~., s~~ ~ F+w~ ; EXEC. IOEAS NO. t 679 r s;~_. _ . . j~~ .~~s~~'~