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HomeMy WebLinkAbout0641 - jf I ~ @ - _ - - . . _ _ _ - - _ y • 3 fHtS FINANCNVG STATEMENT h pns~M~d b o hi~nq oRk~r for hluq p~rrwont b IM Uelfonn Canm~rcbl Codr 3. +uonr.iry da• (d on~h ~ ~ D~b~or(a) lloA Nom~ Ftrst~ o~d oddnss{~s) 2. S~cvr~d Verhp~s) ond oddr~sal~sl For Fpup 01Fk~~ Jpot~. Ttiu~. Numb~r. a~d Fqinq OAk~) ~ ~~.bert, Richard, 3c ~iarci ~-Iousezold- ~^in~nce ror ora ion f11.ED AK~ ~EG~aOEG ~ p ST.IUC+E COUN=Y f~~' 306 Ave M~ PO $oa 3219 ~ocE;-po?1R~s ?t Pierce, ~la 33450 ~t Pferce, yla 33~5~ CIERKC~R~U11C0URT REr~R~ VER~t~ED ~ e This NwoecMy um~o~n1 cw~n ~M idlo.inp hM~ (or a~ms) d Prop~rrl= ~ 3O I219 PM'~ ~ ~ ~ T.~ ,,T S. As~qnw{s) d S«.vr~d Venp ond Addr~as(~s) ~ ~'~LL COI~~T ~f , ~ HOi, ~;:;iOL~ .~OODS. 3~j1c~i ~ ~ ~ ~ b Ch~ M Iro~ [~M ~10~~ rpob~d CAopt~r 201. f.S. Ao~~ b~~n ptoc~d on.1M prpalssory lnslrvm~ny s~wr~d - ~ hu~Al..ad.~9 b. oloc.d oe.sy eddmond oed wu1o. Ms~wm.w~ Mw~ wor b• w sewr.O. ~ _ ih~s sfoNn~~at b N~d ~Al~wl ~ d~btor~ dpiwNr~ b ar(M o s~nrrMp MNeN1 M ooBobnl. (Ch~ck Q M w) ? Alr~od~ w~t11o O~wrrNy NN~NI M owoM»r wASd1Aw ~rh~n p~ros 6~wqAI M4 /Nt sMN. - p.h~ a woo~~ oi llH orqwwl copeNrd e.wlMd a6o.. w.rAkA e s~wrpp wuupt vos a.lw~d: ~n~d ~ k ao.w~d. Q VrocNds of CoBd~rd or~ olso oo~~r~d. ? iradotts of CoYa1Ml w~ olso wr~r~d. No. d oddu~oeol SAN~s D~~t~nt~d: f11~d ~Ilh: . ~ w ~ J - Br By. . ~ . ( e I~~~(s) d D SW~oM.~i.) ol S.a,.~A V~r,,,lN,) ~ r~'+ P1,CE ~ STANDAR~ FORM - F UCG-1 I; fil~.,y Oll~~~r ~oDV •~enobe~•ro . Apptcn~d TOM AOAMS, Sw~tar~ d Sro~a, Sro~~ d Fio~~do ~r~~ .z _ _ _ _ _ - _ r ~.t~~,e:.k , . ~;4;. ~ ~ ~ ~.~x . ~ ~5. "s' _ ~ _ . - ,