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Home My WebLink About0921 . . ~ - , , ` . . ~ . . ; ~ _ ' ~ ~ ; • , - .~°INSTRU~TIdNS ~EASE TYP~~?L`f~~Wti~'?i~OH aei0 spe w~1n pan pqnl p~n Sp~aew~s mu~Yt ~i ip~oN o~ Fruip O~IKN Copws ' iii7xipln~l FinanNl~ $tal~mMl nwnbi~ anA ON~ IdW (in Uwn W1ow~ . • j/~ _ Con1aE(~~in'~ OltKir 1~ lie stMOuN dr a00~IWoa1 mtam~li0e~ t. • - - Y : x~~.•~. Scmind~F8rii1 ~l~`C•3 , { , STAT OF; FL~RIDA ~ ~ U~VI~ORM C~MMERCI~IL ~0~ ~~A MENT OF CHAN~~ FORM UC~~3~AE~1.~19$1 . ~ THIS fINANCINO'gTI~fEMAEN~qiNnt~d to ~ fllinp oINeK la fUkiq pwiwn! to Ihi~`Unlforni G~ommtrelN Cod~: ~~amai~ ~rN++s -ano z mu ~ ao~.e a~cuy 11A ~ns o~+qtnat hlinp'Tnlamalidn a iHfS $~AGE 1~0'~t SE ~~~Lf ~~ER • o~eW6u~ am~nd~d. _ .Y ~ , Q("~ . , -----T-------- Oats.Twni.Nu+~~~afdmqOffic~ ' VJ~~~O i ~E~ b Hami ~~i~f`N'~'Pasool NAME.- . . ' , „ - F~(; FitE~RIQC~ W.°;~~t. , : j tA . , ~ . MA l1~JQ~A00RE55 ' f _ : ' , • ' ~ 49~ M,yrtle Orive ~ " - - - _ C~T`~~ P1A~ ~ ST~TE ' K _ _ . . _r . - ' - , . ~ MUL~T~tpyiE D~~/@~1~* ICF ANYI llast Name ~u~'i"il f'Pe~sonl ' ,5,~ ~NA?l~ll~~ lAilA~ A~ . „ ' < .8 . . ' . _ MAI~~ RE • ` ~e Dr. ~ Fo"rt"P~ "eroe ' FL , .s~~s~;~~~ . _ ~ ciir sti?1E ~ Z . • ~ _ _ _ . _ _ - - . , _ _ _ MULTI ~ EBtOR IF ANY~ ~~La'sFHame Fu~t ~fb PNsa+~ ~ ~ ~ ~Y 11 ~ A~1=~~~ NAb1E - . . ' . ,c ` _ : ~ . ~ i~a~r,~~~ - - i ~MAIItNOAOD~IESS ~ ~ ~~r~F~:lt ~~.i~l~#~- , q . ~ . : o ~ i r . . '~g VI . / t , # ~ _ ~~~C~ ~ C.C ~ Clflf `Sf~TE . (:lJI:~• ~ i~. '~~~j~ ~ . / ~ - -rr<--..,_---._.__._. . ~ ~ . ' SECUREb PAi1fY (lsSl Nym! F~9f i1~~ Caisonl ' "UPOATE ~ ~ NAME . • , CAPITAL~ BANC, --a~ Fla~ida± bar~ing °obrpOratian ` . 2A ~ , MAILINO AOORESS AUDIT ' ~ ~1~ NC7~IWy l~!][aRy . . ~ - . • . ~ . ' . . ' . . . ~ . . . ~ ..n~ ~ . ~ . I ' CIt~l7II) ~ STATE fl~ £ ~1~ _ ~ - t - _ _ . - _ M~E~EC,U~i~ ~PARfV {IF'A1Vi?~ ItsitNartr~FufliiaPa"so.+1 "vAUDAiION'~~IFORM1~T10N NA1~AE . ZB MAILINO AODiI€SS ' " ~~ITY $TATE • ~ ~ ~ _ ~ - r ~ 3: YhYS °''f7a~t~m~nf' r~f~rs ' to" MipYnal- f~nanttrtq SLt~m~t~l • M~~in~ ~fN~'-'NumM~ ''/1UU~ ` tnd fAW+kdh i TM lk' ~aj?w~! IaW on 19 , l~c$~oft~CY~io~iit Co~t~~" t.'L`fici~'CbitltY p `June`~~Il, ~19A5 4. i3`C3midwtwn tF~ brq+nai l~inp sut«n~nt wt«~ t~i tapa4n~ b~etal~? arid S~cw~d vntnN`sl bur~n01A~ oumwr s?aMn aDOV~. is st~+~ ~Ifocti.~ _ ~ _ ; : , . - 5: r(, TMm~na~~on. SKurW ou~Y no 1aqN cfaini! a SlCw~ty iM~r~s1 I~~h~"Nnsnciep abt~muN O~ump tu~ numba sAOw'~`i"sDO.~ - s~ ~ A'ssprnr~am ~tsem 11 ~~A o u OD ~~01 f~n~ catsi a~hsubHt~t 10 ~ifsqement s's~ t~~16ri1~ ih I~Nn t t p~ wnos~ name an0 s0drtss s~i sel (atn +n ~ r. i~ FuU AU OI,S~CUiW P~riji°! ~pnts u.der ttii'~inaneinp S~atsmem nar~ Cee~ ass~p~W lo ~ne assqnae whbs~'nama uW sdMe~s sro sel lortn 'ASS~pnmenl +n Ittm 11 ~ ~ ~ - . ~ - ~ ~ . " ~ - . , , . . . . _ . . , 8. AminOtr»nt- "Fw~snu~q Ststlmfnl ~Hriny htt MImQl~~iMiYA ~60vt i! am~ndld if 31~1 fOrtA in ttNn ti'$iqNtwa Oi plOtd ffquNW ~t Itlm 1! un4lf ~ ~ . am~n0rtwn~ <~anpas onh naen~ b~ sd0~afs b1 e,tMr 0~r 9. ? RNeas~. S~CwW party rNesaes aiiir 1Ae cousn~af dexr~bi0 in I~em fl~'Irom tfi~ I~nantu~p statemem Dearuq f~ nuinbir sAOrn ~pore ~O. ~ Cf~fk'it tr~ Atl dOtumOntary StM~1 IaiN dW and pspa0la ot (0 bltoma dW sn0 pir~bl! pwswnl I~'~AplN 2~t 32.'~ s~ na~. o.s~? oaw 11 il'mai ipae~ ti rpuWed. suath aoat~onat'sM~1s e~S'~'i'~ ~ e . ~ _ . - 800K~~ =PA~E - I ~ - ' ~ 12. No OI AdA~tanai Sne~t! ~~4. SNINATURE~SjQF pEB1OR~Sy`Nit~ssaljiOnl~+FW x I w~sen~eo Ame~wnsnt s« n«n e: . _ ~ _ 13. R~tum Caoir to. . _ ~ . _ - NAME < A64AESS y y' ~~5. SKi ATUNEISI Of SECUREb p11~1110E51Op`ASSIQNEE _ . . _ °~AP~'AL- _ br~`~i` b~anking aor~por~ttit~ . ~ . . . ' . _ . ~ i 8.~= - ~ , ' StA1E ~ ' I~pt,00E a~~ Y~~`~~~t - . . ; s . ~ STANDAA6"~'ORM -~`1~6pM t!'C~~3 "~oao.wovs.u.unasu~•.suua~+~x?~a . FI[INO OF~I~ER "C~OPY - . ~ ~._.~...~.....--.........-_~.w.~._.._..~._.~___..~,.. . ~ . . .