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SLIUCIE CCC`ITY.FI A.
1tOGER POITRAS
~EGi( CiR;.UiT CCUt-
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AFFIDAVIT FOR REGISTRATION OF FICTITIOUS NAME
AS REQUIRED BY CHAPTER 865.09, FLORIDA STATUTES
STATE OF FLORIDA )
COUNTY OF PINELLAS )
BEFORE ME, the undersigned authority, personally appeared
MELVIN F . SEMBLER AND TAMFS w _ wrr SnN, .TR _
i
~ AND
I
I
~ who, being first duly sworn, say that ~x,~rP engaged in
business ir. Flori3a under the fictitious name of FORT PTF.R(`F
MALL ASSOCIATES with principal place of
~ business in St. Lucie County; that the names of all those
interested in said business (with extent of interest of each)
are
MELVIN F. SEMBLER INTEREST 50$
JAMES W. WILSON, JR. INTEREST 50~
INTEREST
INTEREST
(Signature)
L~~R ~ '
(Signature) tom(/ .
J ES WILSON, JR.
(Signature)
3~G`
(Signature) ` ~ ~ =
SWORN TO AND SUBSCRIBED before me this ~-`~~d~?y~of' `1
~
~~Rtem6er , 197 9. ~
~ e .
ao~K PaGE ~
6 ~OEO Ir~RJ C,~':~~2 L IuS. u,+~:K,~61aRS NOTARY BLIC