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THIS HPIAtrCY+ICa STATfMGB if pwsnMSd b a ~D offw? for film punwr b >M lfnifaw Conanuc~ol Codh - 3. ff~otusUp dab IN atw:)
t. Osbbtbl cost Flaws Rht1 and oddnssNsl Z. Ssaws;. lbrtrlwd and addrswissl fo. Rlino Offios. (Oab. Taa.. Nun+ba?._
ERGLE FINANCE a~~~'QO~
~ 1dALLACl3, VIYY.AN ?A57 S? FEDERAL HIGr':=~Ay
Po: sax 1963 F~ PIEBCFy FIABtDA 33450 459918
Ft. Pierce, FL 33450
This finartdn0 statstttsr~f asrws tlr isNowisq tfpss lo? itsws) d ptaputys
AS P8R SCHBDULS "A'! HOIIS$HOLD QOODa - s~~•ydrjvCE
_ $05: FEBEAAI, NIGHg4iq~?
I'!', r~E$CE, FLOAIQA 3345Q
6. The ssa~nsd porryW. whose si~otwobl a~saes bsiorr, stetss that dr sbs+ps mquiwd by Uioplfr 201, -
fbrido AahAef. if anp, hors boon Aloud an the praaMSSar w~grunwrs asaeod hasblr, and wi{ ho -
olacsd on an{r adfitiawl and swrlor itiA~ansnt 11~af wny b• w ssowad:"
This stasnnsnt is filed wi/spA >M dsfifsrs sipnataw b ptisR a ssawifi? intswst iw oorotergl. (andc ®if so) -
Altsodr subjsd b a sstawiryr inlM~ft in onotlw ~ursdktion whew i woo broudK info Ilrt slots.
? Wl+idti is goatsds d 11r arigirwl oeMossrd daaibsd abort iw whkh a stianiyr ieManlsf woo psrfs~]sd:
GMtk ~ if atNasd: ~ f+toasds d CoNatrnd ow aha asrswd. ? /todircts d CdWfnol ara.~±ao at~road. Flo. d Addtionol Shoats pwssnbd:
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