HomeMy WebLinkAboutRay Selph Filled Land AffidavitMim
N DEVELOPMENT SEA ENT
Build' `cad Regulations Division
FORT PMRCE, FL 349 -56 2
(7) 62-f66
FILLED LAND AFFIDAVIT
the undersigned, am the owner of the following described rea r ,
(Parcel IM/Le f description/Address)
Tres Teri a a r Samoa Date
{ #'°1 w act IS FE �SONALL KNOWN TO Nr ) OR is It s
AS IDENTIFICATION.
PRODUCED Ck-
SkGNA L OF NOTARY UBLICTYPE PE OR PMNT NOTARY
3'i T '�•t ObSAISSTON s+itlMBER
(SEAL)
Cam k Qub=
SLOP SD R ov sed 04/1 law 1 Notary Public
State of Florida
Commil HHC
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