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HomeMy WebLinkAbout1067 i • • • ~ f I i,I I{f~ [fit t 1 k TM1S flfiAilClfVCr STATEMENT it ~r.t.wld N • fAiiy .filar filiwo Nrtvewf a fh. UnAtxs. C.wr..cc:ef C.dr. 3. Mdvrit~ d.N IN .w~): i; 1. fathwr(ti (L•M Nr. i'wtt) •w/ ./drat(«) 2. S.c•r.d fa.rt,li.t) atird uddr.tsl.t) h. rry Otlas+ low. M..+«...~ ~c.~ oMa.l Jim Cain Jr. Ingram*a Home Appt., Inc 4~~.~ 7t0 N. 18th St. P.O. Box 907 l'. Pt. Pierce, Fl. 33454 Pt. Pierce, P1. 33454 ~I9~ •7 ~ Z Trlt ?:r•wdq a.t~.r.t e•t.rs bv« I« ilwt) •f IK•.•m: Maytag Dishwasher 500 (Serial) t49236CT l~OMi White-Westin house Range KP435AH (Seriat)' g BCA 12219 s. Na,~»c•, s.ar.d nod Ad+r.«t«~ Sun Bank { 4~8.~ Orange Ave . T>t. r.c..a va+rr(ti .f o. q..r..l+~ arwa++ wt...a.. ~ +..wc »r.+ e. Cl§tt.. ~o: f b.dt srsw.. / trrr. b.. ftw P t . Pierce , P 1.3 34 54 ' rbcd o~ ron.~try .a......c..d f~tAr. t.e a bt .bc.a d .w aedrwa+ ..§e v.io~ .«..w rb .wr br ,o ..c...e TA:t tta#tw.M fs fiNd ..:tA..f dr dtlc.r't tiwM. h WrfM • tatw:fp :nttr.tt w c.ll.Nr.l. (Ch.d ®:f te) ? Alr..df N • Narrdl iwlMNt iw weNnr Mritdicfi.w .rMw it .an br«7Ac iM. IA:t ?teN. [ § 0 .Iflltfl b MKMdt O< th. txi~:w.f t.~ltM•~ MWdt.d Yb... :M ~h:th • fKVrit1 :nt.r.t1 ~.t p~rf.tNd: f CA.ct ®:f tw.rtd: ~r.c..dt •f Cetlwrd a*..it. c...r.d. ~ Ir.ducM d CoN.tuei er. dw te..rad. Ne. d .ddir:pwl SA..rt P..t.nnd: F Tif.d ~lth: 'St Lucie Count ` ~ .nom`-e ay. b• d O.W.r Sit..f~rr.it) a< S.avr.d 1•rtf::s! JSi~w.trrN~ ~ J-~D~ STANOARO FORM -FORM UCC-1