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THis F1NMKING STAIEMB~R h prssenbd b a fiNno aHirar ter Niy purwor b M IJnil~srw . Corrrner~iol Code: 3. Malurkl? dab fit aa~1 . _
1. Debbr(s1 Iloit t+larrre first) and oddnss{es) 2. Sowwd /lert2(ies~ and addrs~sele~ for f~rlieg Officer pole. Tirwe, fiurber,
AI~tI~ L & MILI~tBa B LAPIIiLS EAGLE FINANC'8 °"d ~o o~i ~
P.O. BOX 3265 .
1501 s. 33rd st. czos7 s. FEDERAL HwY.~ 435239
. PIffiZCB, FLA. 33150 Ff. PIEKt~, PLOItIDA 33450
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Thh firgncirq sbbwrMll QOrers Mf fOYOwir1~ types fa Ib7M~ of py~ep~erfy,
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S. Aesiprree{s~ d Sownd iworyr AddwsNMl s
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~ P.O. BOX 3265
6. IM second oorMsl. whore sipnolrwels) appors bbw, slotw shot Me asowpe r.q~dwd by Q~opbr 201. !2057 S. FEDERAL
f>o.ida sbarln, if orrp, ho» b..o pbad on Mo praows.ay irs>1rwa.na sen~.s herabir, ara wip be F'?'. PIERCB, FLORIDA 334
placed on any oddiliaal arrd aiwrlor irutn.n.rrt Mot roolr <s. « s.uwoa.
Thh slobrrwot h fiMd wilhorf du de6br"s siynalrrro b perfect o seowify irMewet in ooNrMerd. fCMdc ®if sal i
Q Already f~i6~ed b o tecwitl? iMMasl in orrollrr ~risdction when If was bncrplM inb Mis slob. i
? Whid+ h proceeds of Mn oripinol aollorerd described abwo iA whirl a searritlr irMerty/ was perisded:
CMek ®if oorerod: ? f+roes+eds of Colbbo! an ohw aoMwd. ? f+Vodros of CoileNrol an also eorered. Hlo. of Additiawi Shoals pnseerod:
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STANDARD FORM FORM • 1 fAL'£~~ ~
_ a .Id~r~ s.~,:. s.a.,~.y of ser»., s.~. of Fler~d~ .
f7QC. IOE/1S NO. 1 f179 -
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