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Affidavit Under Fictitious Name Statute f
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STATE O!~ (FLORIDA
SS.
COUNTY Of ST. lUC1E ~
The undersigned, under oath, says: That he or she is engaged in a business enterprise under the
fictitious name of U S T 0 M HOME DES 1 G N
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3747 JEANETTE AVE }
located at _
JENSQN BEACH MARTIN COUi!TY FLA
in the City of ----------------------------------------,~C4~.'~La6~+~~SJ4~f~~lbiiib~
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Those interested in said enterprise, and the extent of the interest of each, is as follows:
---FR j E ORJ C.H_ ~_~~LK------------- -------1fl.Qa?-------------------------
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Proof of publication of this intention to register, is filed herewith, pursuant to the provisions of
i Chapter 20953, Laws of 1941.
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FRIEDRICH J Aut~c
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MARCH 79
Sworn to and subscribed before me this 6__ day of 19_____.
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ROGER POITRAS
CLERK CIRCUR COURT Notary Public -
By - ---~~5~______-- D.C. My Commission expires------------------- }Y
5 y,.'~~'. rti i/jt1~'
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_ ~o~1~3U4 FA~E1389
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