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THIS fMiANCAVp STATEMENT N /ro„tM,d N e AWN eAis.r (e+ A!y ve.«w>,t w the Ilrtihre, Getteettiei Ceder 1. Mebrih Bete eef)~
1. Debter(,) (teM Never fires) eed eddnwlesl 2. Se,twed fvAT(iea eed eddnw(e.) fer ftfy 01Aa,r (DbU~ 11ra.. NewMr, e.d fWN O?!M'
Mr~r~raorr, TERRx ICE cErr>r~,r,. Firur~cE ,4;;x'7'7
1203 N. 21. St. P.O.BOX 370 ; CG~UrE'
FOR' P~ ~ FL 33450 ~ FORT PIF~tL'E f FL 33450 ~ r ~ ; U ` - L .
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4. Thi, Aw.wciy ,atrewwf oOrer, fh (eWtwirN hive, ler ~ « Ir.payr ~ 3 2
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~ All e( the cowsttwer peels rtew bcetd in K ebesM the vrewi,ee censtiwtinv the debMri nsidewee et 9 U~..!1 ~ O ~r
their ddreee ebere set Ferth er .t etr other ddre,. N which the sere eieT be reword and awT vreverhr 9 .
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liad below. i ~?•~tte..W d Stowed f~rh: ettd
~ The (elbwiM Melt -
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6. 1M wene..enrll..,n. re+.M.tY .ww+ Mtw. res. e„ r.yr we•ti~ 4 CLre,w lot. Rrid, i~R N w. 1..r Mr
N,u. • er Pe~,r,W +r,rw~U rra~ri ,r,.r. r/ A M .4w. ~ e~I .i/ea„t eve/ ,iwlW i,rYr~r r„r i, w rnw.i. -
This steMweet h fAed wiNtoet the dsbtar's ,iPtowre M perteet a s.awiy igtged iw soRoterol. (Check ®ff M)
Q Alreody wblocf to a wcwihr iwUre,l ie ortodter iwisdictiew w#ett N rres brarvlM htN thb ,lete._ =
~ Q eAti,h is vreo,eds of the erivinol .ei)e„rel iswiied eMw itt wAkh a seawihr hrtereM v.ee verfectod: .
cMck ®N oersredr D hexed, of CeWtbre( ere vise cerered. D frodeds of GEeNrol en ah» oowred. Ns. of edditiowel Shsets Pee•wt•4s -
Fit.d S'P.I.tJ(;IE COtJMPY ~JRT HOUSE /
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Forty 1700 Sipteeerets) of DeMe?l,) ~r,rr ~ `~~0 SiowewwtrU of Seoxed fery(i.,)
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(i_) FllnttiG OFFICER COPY -ALPHABETICAL: /?ow~+ed bT lokr) S?e... sar.+arY otf st.i., sl.te of fiorida