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T?IIS FIMANCINO iTATE1YlENT i, P.«.et.e fiin0 ettkw ia. fiwq pwrweM t. e» uiar.n. c.~«rd CeM: 3. Mew,;t,, ee» (ii .e,,: T
4 1. Deter(s) (loM Mari Rnt) ewr .ddr.rs(«) 2. S«w~d Mt/(i«) .w~ edb+.~(«) ?+•ee~~~~• «r tay tltriwl
T.K.R. OF FORT PIERCE, INC. WALGREEN CO. F
2501 U.S. 1 200 Wilmot Road ~ ~ ~g
Fort Pierce, FL 33450 Deerfield, IL 60015 ~ ~
This tle.~cte~ a1el...d c..rra t4. f.w.wM. r.... (er +trs) e/ /r•v~tn i
State of Florida 6-COP Alcoholic Beverage License No. 66-23 ~~1~
issued to debtor and currently in use at the "Other Place"
at 2501 U. S. 1, Fort Pierce, Florida. A"i'"m`) ~ .er A°+~«) i
6. Tb ecwd ~a~r1~(.l..~or. sy~ar...(sl a,o.on b.b.t. eotw iar ate reeve ~+V.~~d a C1ay~ 101. f6ris Lis. i aq. 4.w Iww
pioc~d a i. poYa~ rnw./. wKw~d Mnb?. ad .ri ~ 0~~ a e.r addtad ad Dior w~.eer Itd eqr ~ o rcw./.
f This goNw~M b tibd withwt the d~bers sigwetrre to pNfecf a sewrklr iwNnsl M celleNrd. (Cheri ®lf M)
? Akeed~ ~d a e wawky ingred in anetlw (eris~etiew wMw h wo bra71M iiNe thM steN.
a Q whicA is pecM~ of 1M erioiwd ceYot~rel dMa'M~ ebew iw whirl. a «swk>/ iNU«t ~rer pertechd:
Ch~cte ®if ceverett: Q /rover of Gpol~rel ere elw cmrered. Q hedrets of Collelerel ae ebs oerered. Ne.
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i~T:t Otx Shr, Vice President
: STANDARD FORM - IJCC-1 : ~ _ - E~ ,.r`-
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't~'`T(i... ~y,,l~habetica! Approerd N . Sa*erw of s~.+e vre t,
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