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THIS STATf:MElR if txwawwad M • fiGM elfiar (er filiM swraeowt a tM lfaihr~ CwfNrciet Cede: 1. McMih dea li/ ewr{~ ~ .
t. Detsterlf) Ileac Hose Rnt) and eddreawlod 2. Severed ?erftrlies{ ewd wddrefalea{ ~~i er filiM Officer (Dea, Tifae, Me~Mr, ewd filtw~ 1
FLORIDA BANK AT FORT PIERCE
Horn, Eligen Joseph P. O. BOX 3469 _ CQRUED
1786 Westmoreland Boulevard 501 ORANGE AVENUE ' ' - ~ ~ i_ a.
Port St. Lucie, Florida 33452 ~~PIERCEfFLORIDA33450
TAif ffoNatwaf ee/ers N eriw fiwoociM M R tM. +7~ ^ ~ _ - ~ C
Clerk Circuit ~ourt , .
Luce ~o J a
fitw .~iw oea (iced 11Z~- ,
S. ? CMrw11M- TM erieiwel 6wawciM atesf~ewt Mhreew IM fwrgNM DfWer aM SsKere/ Iorh. Merits fiN pafber s?es.w e?s», is atitl eftecNne.
d. ~ Tewwheliew. SecerN Oorh- w lewpr cleias a feceriy iwleretf ewMr 1M fitawciM alete~ewt beeciM fiN wtinMr srww aM~e. r _ ,
~ 7. ? Aesi/t~eef. iAe severed work's rips awder Mr fiwewciM steM~ewt Maritp fiN weber Ae.rw mbe~e a He weoertp ::;;:i`.:i ~ .!trs ~1{jitea -Ueew a>h1ta~1
a tM easi~wee .Mae nee ew/ eddreaf ewwew V Items i 1.
e. ? A~enLsar. fiwewtiM SIele~ewf Merits file M~bM show ebeae if e~eMed of fe1 (er1A iw ItN 11.
9. ? Rslewee. SecerN tech nleews the ullelerel describN iw Items I1 fns fM fiswwciM steawt be«iM fits weaber sM~w shave.
10~ rift if law Ap dete~Mfery stew Naea dw wwd we>eiaM er N beces.e des wwd M1pM peneewl N CMper 201, f. S. Moe Mew void.
11. Equipment a8 follOVS
2 Glacier soft serve ice cream machines model F-1
l used crystal tips ice maker stainless steel .top enamel case ~
i
1 lancer ref. counter model soda unit to dispense 4 (lavers i
3 carbonated 1non-carbonated plain soda and. Water co®plete installed
f1e. of od~fieoel sMeM ~
IRS
s f weceasery ewy 1 Iffw • is ~ Is) of fartrliea)
STANDARD FORM - fOR - U C-3
(1) Rlinq Officer Copy-Alphabetical Aww•••d.h tkb.rd low{ st.w.• s.rr.ary of sat., saa of fl.rld.