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THIS fMIAt~CMiG STAIEMBif is peseiMed a a f~ officer for ffliq purw+ar b the lJnifenw Caarnaoef Gods: 3. fAMwitp dote (if any+)
I , t ffotwe F+.N and oddiessW Z. Sroo+d Ibrt w~ss~ Fw Filing OifioK (Date. Tin». Plui~Or.
B'AGLg Fjjv ~ aid f;lino ofiloel n,
MAATIIi C: do M~It?!~A A~ND~i p.0. BOX 3265.
~u ~ s~xaar ~2os~ s. t~DERA~ .434.259
FP. PT~CB, FLt. Fr. P1E1;CE, FLORIDA 33450
33450 ~ - _
4. This Ananc+q W~MIr oerere:tlr foMoersty types (er ifew~tf of pnepenln -
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A3 Pit 3C8~"JIJLS "A" RWS~I.D (300iD8 SC.7PINANCS
- .O. BOX 3265
2067 S. FEDERAL HyV'Y~.Y Y
a. The seouesd pony(s1. ~rhose «v+~.t appsan the br ems.. zof, pIERC~, FLO1tIDA 334 ~
Florido Salutes, If any, bar. be.n pbwd ow the paow~issorr iiwnerMrys e.oiw.d hereby, and .nil be
paced at anp odditionef and aenibr iMn.weuf thot essy b. a esorred.
This stoteniur ie filed .rilhout the debbr's sipnauw b ported o ssasitlr itraes? in ooNolsial. iC1wd~ ®if sod
? AMeadl? *~b jed b u seaRilp i~eeM i~ ano+~. ~r+~dian ,.h.n i .ia. 6~wrpht :Ma flr. ,bl..
? VN~fi is procwds of the orgi+ol mlloserof deecrib.d abort in .hide o seaRity i rros p.rfacted:
Chad ®if corer ? Proceeds of Caftot~e.d ale abo corerad. ? /raflt+ds of CoileASiol ae obo mrerad. No. of /Idditionoi SheW pesent.d:
fiMd rsiillt.
SiOrroMeW of Oehlaris) SiDnowrel Fbrtylies)
geoK 3~ 1~ STANDARD FORM -FORM . ~
by IGdrard l0ict) stone, Sscr.tory of Stole. sroa of FlwiAa
. ~ ~ e c ~ - = ^ ~--PHASETICAL f71EC. IOE/1S Iii. 1b79
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