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HomeMy WebLinkAbout0097 a ~ i ~ iM75 STA?EMENS :s p.~s~~tsd b o f~t~np oHk~r ior Rl~nO pu~iv¢nt ~o fb~ lJn,fcrm Comm~~c:ol Cod• j 3 Mpruri~y dat~ ~11 anyr . 1 ~~bb•lsl ilos~ Nom~ Ftn~; ~~dr~ut~~; 2 S~wred Gar~yi~~s! ond odd.ess,~+- ~ fo. FB~~q O"rfK~r ~Doe~. i.m~. Numb~r. ~nd Fvi~n9 ONKf~ `v~lx~r Ji:~re ~ Sar~.:~ H u~ ~ ~ FILED~MDRECOROEO ~ , o_~ehol~ Fi: z.,ce CQr~. ST~ROCE CPO TRAS« 12~~• I~ ZC'V:i S`v. 1l~1.~ .:di'tCl c_'•.U S~• CIERK CIP.CU17 ~ t 2 N't. Pierce, ~'l:z 33',~e p~,.;,-_, ~t, r't. Picrcr, FZo~ ic3a ~ tiC . SEP ~ ~ 12 a3 PM'~8 . i fAis Na~m~n~ r~i~it b or.pf~ol Ftnpnc~nq Sb~e~n~n~ p~or4~y FY~ No. f~±~d.~M ' Oot~Fq~d I9 S? Conn~vorwr. fA~ onp+nd knanc:eq ~ta~.n~n~ b~n.~sn M~ bnpo~nq C~b~o. o~d S~cu.~d Por~~. O~onn9 ht~ nv~++b~. s~o~~ oEo.~. ~s ~~~l~ e!~er~.s 6? f~rminoliow S~cvr«J port~ wp {ony~r tb4n1 O iKVrffy M~~r~f~ und~r M~ finonciny sbr~m~n~ O~o•~nq Rte ~vmb~. sho..~ oMre ~ ) a AstpnmM.t Ih• ~~wr~d pmt~'~ rtqAl ~~r M• fieonelnp uoqm~n~ b~orup ~Hts nvmE~. sho+n obo.• eo th~ o~oa~.er d~at~,b~d .n ;ie.n 11 nos been oss~y~ed b d+~ oa~qn~~ ..hos~ ..om~ ond oddr~~s oppw. 1n U~m 1 1 ~ a. ? A~n~nd~M~ frwncr.p Sb~w~n~ bwraq ip~ nvmb~r ~AO.n opo.~ y aw~~d~d w sN IorHs in d~m 11 9. ? R~Iros~ SKy~~d Vwq ~~I~os~~ collohrol d~~uib~d ~n q~~n 11 I.o.n M~ hnonckp sb4m~n~ ~~o•~ny f~t~ ~u~,+E~r sho..n obo-• ~4? Ch.ct r~.,,. AY doWm~nbrt swmy b~s dw ond pe/obl~ w b b~co.n~ Qv~ ond porobt~ p„nuoni ro CAov~~r 1QI. F 5 ho.~ b~~n po•O i 11. :~.1 :10~~_i5(,'i'.O~`.) :.1 CO~ ~tV~.Ll ~O'J`I:~~ • ~ d ol ~h •s~nf~A GtJ~t~C.~C~-c~ ~ 'l~f' _ . ~y _ /~Jl.C"~ ~iL/~~ ~n ey ~,~:~~a.~++~ 1~r~~w..v~ - Sly~dw~ e( O~bb~(~) (n~c~»o~t onf~ M N~ d H opplrcob:~! Stynoh~.e;~2 d 5~ V ~I ~ , . .,,oar~:«~ STANDARD FORM - FORM UCG-3 ~ ~~4 ~ ~~.o..e e~ ~oM ~o4,as. . ` _ . - _ . ~¢w