HomeMy WebLinkAbout17-18945 CITY OF ZEPHYRHILLS
5335-8TH STREET
. � (813)780-0020 18945
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 18945 Address: 39628 MEADOWOOD LP
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: MEADOWOOD ESTATES
Est. Value: Parcel Number: 13-26-21-0140-00000-0980
Improv. Cost: 5,384.00 OWNER INFORMATION
Date Issued: 10/17/2017 Name: SMITH REBECCA L &WILLIAM
Total Fees: 65.00 Address: 6222 SILVER OAKS DR
Amount Paid: 65.00 ZEPHYRHILLS FL 33542-4807
Date Paid: 10/17/2017 Phone:
Work Desc: REROOF SHINGLE
CONTRACTOR S APPLICATION FEES
WIDNER ROOFING INC REROOF RESIDENTIAL 65.00
1
C�'� '� �
��� �
Ins ecti s e uired
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP
FINAL
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
� �
C TRACTOR SIGNATURE , PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
_ � CITY OF ZEPHYRHILLS
` 5335-8TH STREET
� (813)780-0020 1894•/
BUILDING PERMIT
PERMIT INFORMATION LOCA ► N IN ORMATION
Permit Number: 18945 Address: 39528 WOOD LP
Permit Type: RE-ROOF ZEPHY'RHI S, FL.
Class of Work: ROOF REPLACEMENT Township: a e: Book:
Proposed Use: SINGLE' FAMILY RESIDENTIAL Lot(s): Bloc Section:
Square Feet: Subdivision: EADO OD ESTATES
Est. Value: Parcei Number: 3-26- 1-0140-00000-1230
Improv. Cost: 5,384.00 OWNE INF RMATION
Date Issued: 10/17/2017 Name: DIAS D GOS &TECLA MARIA FATIM
Total Fees: 65.00 Address: 39528 E OWOOD LP
Amount Paid: 65.00 ZEPHYR IL FL. 33542
Date Paid: 10/17/2017 Phone: (852)71 ,-4802
Work Desc: REROOF SHINGLE
CONTRACTOR S APPLICATION FEES
WIDNER ROOFING INC REROOF RESIDENTIAL 65.00
,
�,
�
Ins ections Re uired
DRY N ROOF INSP
TAPE JOINTS ROOF INSP
FINAL
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications Must Accompany Application.All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
� CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
. - - -
' � IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIilllllllllli
• 2017163288
Pertnit No. Parcel ID No �.3"�-2�`O/�—���— [�Q��
NOTICE OF COMMENCEAIIENT /f
State of,�� County of Q�C.�
THE UNDERSIGNED hereby gives no6ce that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
lhe faAowing infartnation fs provided in this Notica of Cammencement•
P P rtY• � —�.�i a-������— DO000_ O B'Q
1 Descri lion of Pro e Parcel IdenUfication No.
StreetAddress: .���Z-� /"l��C - S
2. General OesaipUon of Improvement ti� c, � ��YEt.� S�$'(
I3. Owner Information ar Lessee infortnation ifthe Lessee con6aCed forthe improvement:
I � � rr�� �
. --�2 22 Na d.=�Y—*x1-��� 7
Address City State ,� �� �
� Interest in Pmperty: ���L 3 3,}`t' � �L
� 0 '• �
Name of Fee Simple TiUeholder. �
(If dif(erenl from Owner fisted above) �� ' ' ,�.��
Address �-� � CItY State � m � �•�� a�� � �
4 Contrector. � �
Name � o�.�� t'� �w., � �'
Cit� � State � �._ J � "�a' o
�i �
Address �— om • y'
CantradorsTelephone No.: S�3- 7C�� bS 3 ( 3�Sz3 � � q'-''�'�. �
� h� �
� w.. . ��„
5. Surety: '
Name � �r �j
Address City - State ���9 9 �
Amount of Bond:$ Telephone No.. � �
6. Lender.
Name
Address City State Q F— W Y
Lenders Telephone Na.. o � � � (/�� W �
7. Persons wilhin the State af Florida designated by the awner upon wham notices or other documents may 6e served as provided by � z � 0 �Q J y�
Section 713.13(1)(a)(�,Florida Statutes: �,� — U � J O �
Name �` O 0 1— W N � W
� � = z J � o
Add2ss City _ State 9- � �` � Q �
Telephone Number of Designated Person: f� � („)
� = 0 0 — �
8. In addidon to himself,Ihe owner designates ot � ~ � W � Y
lo recefve a copy of the Uenors Notice as provided in Sedion 713.13(1)(b),Fladda Slatutes. � Q O � � �
Telephane Number of Person or Entity Designated by Owner. = U U z �1
'� }— F— J Q -�
9. Expiration date of Notice ot Commencement(the expiration dete may not be hefore the wmpletlon of canstructlon and final payment to the � } U m � 1i U
contrador,hut will he one year from the date of recording unless a ditterent date is speGfted): L� � � � Z O
Q }
i WARNING TO OWNER: ANY PAYMENTS MADE 8Y THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT o � C �l = p _
RESUI�NN�YO R�PAMYPINGPTMCE ORMIMSPROVEMENTS OY OUR PROPERTYnA NOTICE OF COMMENCEMEN MUST BE � U U � � O
� RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT � U � �
i WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. O H- z � (n
� Under penatty of perjury,1 dedare lhat I have 2ad the faregoing notice af cammencemert and that the facts stated rein are lrue to the 6est � � q J � �
! of my Imowledge and belieL p— W J
� 4 � c� � L1_. � �
STATE OF FLORIDA • I-- _ � Z Q }
: COUNTY OF PASCO ��� � �" H O � � m
NMary Pudie Sfete d Flaide
Sherty Wdrter � e of Owner or Lessee, r Owners or Lessee's Authorized
"� �g� My CommFselon�o OificeNDirecto7PartnedManager
W wa' Expitas ty08r�077 75185
, Signetary's TiGelOffice
� The foregoing InsWment was a�Jcnowledged before me this/3 day of D� 1 ,2�,by_ Ur 1( SJ-((�
as On.i11/`Q/L_ (typ of a ority,e.g.,officer, , tee,aHomey in fact)for
( o rty on ehalf of wh ins errt as xecute�.
Personally Known �R Praduced IdentiflcaUon❑ Notary Signat
I Type of IdenUficaUon Produced Name(Print) S ff� �
Repf:1902022 Ree: 10.00
; DS: 0.00 IT: 0.00
10/17/2017 J. R., Dply Cle�k
�`ppllLq 5 0'NEIL,Ph.D.PRSCO CLERK B COMPTROLLER
, wpdatarocslnoticecommencement�c053048 10/17/2017�1 39am PG gf���
OR BK 9 19 3
. - ° !11l1!!Illll I!!Il lllll IIIII Illll I!!!I�II!!IIlII IlII!IIlI Illl
, 20'1�'16t754S
Rcpt: 19D1II95 Rec: 18.50
DS: 595.00 IT: 0.00
10/12j201? eRecordinc�
; re ed b�and retu�:
3oseptZzne Lee�ar�tzn,�ol� PA[1L�S.O'NEIL,Ph.D.P,4SCU CLERK�COMPTROLLER
Meridian Title Company,Inc. 10 ji2 j2o1? 04:08 P23 1 0� 2
37837 Merzdian Avenice St�ite 104 QR B� g��� P� �r4��i
Dade Gity,FL 33525
3S2-SG"7-1241
File Nun2ber: 17-09-22JL
SAL.ES PRICE:$85,000.00
(Spaee Above'Chis Line For Recurding t3ataj
�a�'�`�Il��' �E',�C�.
This "t�4Tarran�y Ueec� made this � �day of �,�Gi�U�`3-� , 2017, bet�veen
Domingos Dias,a married rnan,whose post offsce address is 7641 3eno Street,Zephyrhills,FL 33540,�rantor,
and Rebeeea L.Smith and'Willianrt E.Stnitl�,Sr.,wife and hus�and,whose post affice address is 622?Silver Oal:s I�rive,
:�epliyrhiils,�E. 33542,grantee:
(�V3�enever used hcrein tlfe t�m�s "orantar" ancl "grantcc" inoludc all Ihe parties tv lhis instrument and the heirs, lcgal representotiti•es,and assi,gns of
individaais,aat3 the sua:cessors and assians ofcorpnralions,trusis und trustees}
�Vitn�sse#b, tl�at said �racaEor, far and in consideratio�a of tt�e sum c�f TEN AI�tD NQI14Q D�LLARS (�10.00)anti other
gaod and vatuabie considerations to said grantor in hand paid by said gran#ee, the receipt wherepf is hereby ackno��iedbed,
tzas aranted, bargained, and sold to tlae said grantee, and ?rantee's heirs and assigns forever, the fatlo«ing described f�nd.
situate,lying and bevng in Pasco Cou�fy,�Iorida to-wit:
Lot 48, 1�IEADQW003� �STATES,scecording #o ttte map or plat thereaf as recorded in �'!at 8aotc
I5,Pnge 106,Pubtic Records of Pasco County,Ftorida.
,
Parcel�dentifcafion 1Yumber: �3-26 21-U14t3-QOt}00-0980
THE �'ItQPERTY B�ING Ct}NVEYEI? HEREtirt DU�S NQ"�t' C(?NST�TUTE ANI' P{}BTI4i� OF THE
HONi�STEA�J►PROPERT'1l Or TI�iE GRAI�ITOR{S)H�REIN.
Togeth�r Hrith ait the tenements,heceditatnen#s and appurEenances Ehereto betanging or in artywise appertaining.
�'n I�ave an.d to�ol�,tize same in fee siinple forever.
A.t�d the �antor lierehy covenants ��riEh saici grantee that the grantor is lawfiully seszed of said lartd i» fee simple; that the
grantor has goad eislrt and lawful aukhority to seil and convey said land;that tl�e grantar hereby futIy warrants the title to said
Iand anci wiIl defend #he same against the lawful clai�tas of all persons whoinsoever; and that said land is free oE a!!
encumbrances,sscept taxes accruing subsequent Eo Deee�nnber 3�,20�6,zoni��;and/pr restrictions impased b�+;overnmentai
authority, and easements; restrictions and reseivations of record, if any, however thi� refereiice shall not serve ta reimpose
same.
� DpubteTfine.
� - ' oR BK 9�17 pG 3499
• 2 ot s
In V4Vitness W�ereof,.grantor has hereunto set grantor's hand a�id seal the day and year first abo��e written. 'i
Si e , ealed and delivered in onr pre ce:
-n.�t}�5..��`�`C��t L�E.�Lj/�. • l ll'r'C�9 f tij a S �I!�'/,���
Wiiness: �����n i�nG�'1 i �,����� Dominaos Dias
Printed Wim ame
J�
�
lttl� 'd/
Prinf�Witnes Name ,n • . � �--e-'�'�
/ I ��zl� �
State of Florida
County of Pasco
The fore;oing instr,umerit was acknowledged before me this ��--day of �C��a� �01? by
Domingos Dias,a niarried man,who[_] is personally known or[X]has produced a c�rivei's license as identification. �
�
[Notary Seal] Notar� 1'u c
l
Pr nted Name:
,' y Commissi Expires:
��'JOSEPHp+;g
�Q,� � ��S�wY�2p�
��
FYarranry Decd-Page 2 DoubleT[I71e9
s�aaso-oozo City of Zephyrhilis Permit Application Fax-813-780-0021
. . ' Building Department� _
Date Received ` �� � ,� � Phone Contact for Permitting �l 3 .� — �S 3
Owner's Name t { ( ��'-'L� Owner Phone Number
Owner'`s Address �2-ZZ-- c� � ��l V4� r2 Owner Phone Wumber
Fee Simple Titleholder Name Owner Phone Idumber
Fee Slmple Titleholder Address
JOB ADDRESS 3��ZD � � , LOT# �
SUBDIVISION PARCEL ID# /3`oZ.�-� � O� � ��m� -- Q ��Q
j j � (OBTAINED FROM PROPERTY TAX NOTICE)
�j WORK PROPOSED e NEW CONSTR B ADD/ALT 0 SIGN Q Q DEMOLISH
!r ' INSTALL REPAIR
i� PROPO�SED USE Q SFR Q COMM 0 OTHER
�fi TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
�j DESCRIPTIOId OF WORK S F � c
�
�I BUILDING SIZE SQ FOOTAGE� HEIGHT
� �
1
� QBUILDING $ ip � VALUATION OF TOTAL CONSTRUCTION
!f � �
�� QELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C:
i� ,
i OPLUMBING $ ,
�' QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION (�`��
,� �
�, QGAS � ROOFING Q SPECIALTY 0 OTHER
� FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
,t
i
w
� BUILDER COMPANY
i SIGPIATURE REGISTERED Y/ N FEE CURRE� Y/N
� Address License#
4
� ELECTRICIAN COMPANY
� SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
a
a Address License#
�
� , � ..
� PLUMBER COMPANY
� SIGNATURE REGISTERED Y'/' N . FEE CURRE� ��Y/�N'
I :
i
Address License# .
MECHAfVICAL. COMPANY.
' SIGNATWRE REGISTERED Y/-N. FeE cu�en Y/N �
Address License#
OTHER COMPANY t �''�''�
SIGNATURE {x��C��, REGIS7ERED Y/ N FEE CURRE� Y/N
�.
1 � CCC-a����z--
Address D D�-vvL License#
�°. RESIDENTIAL- Attach�(2)Plot Plans;(2)sets of Building Plans;,(1)set of Energy Forms;'R;O=W Permit for new construction,
;`", Minimum ten:(.1:0)'.working days aftersubmittal date. Required onsite;=ConstructiomPlans,Stormwater Plans w/Silt Fence installed,
-. Sanitary Facilities&1 dumpster;Site Work Permit for subdivisionsAarge projects
COMNiERCIAL Attach(2)complete sets of Building Plans plus a,Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittahdate. Requi�ed onsite,Construction.Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities'&9'dumpster.Site Work Permit for all'new projects.All commercial requirements must meet compliance �
` - SIGPI PERMIT Attach(2),sets of Englneered Plans. _ ,-
*•""PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice�of Commencement is required. (AIC upgrades over$7500)
" Agent(for the contractor)or Power-of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUIdTER PERAAITTING ' (copy of contract required) �
Reroofs if shingles Sewers Service_Upgrades A/C � Fences(Plot/Survey/Footage) �
Driveways-Not over Counter if on public roadways..needs ROW
:., ,
` :
NOTICE OF DEECI RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" r,�:strictians"
which may be more restrictive than Cot�nty regulations.. The undersigned assumes responsibility for compliance.wi#h:�ny
appticable,deed;resteictions. . . _. - � � .. .
UNLICEfdSED CONTRACT4RS AND CONTRACTOR. RESPONSIBILITIES: If th� owner has-hired a contractar or.
cantractors ta-undertake v�rark, #hey'may be required to be licensed in accordance wifh state and local..regulations. If the
contractor is not licensed as:required by law, both the�owner and contractor may be cited for a misdemeanor violation.
under state law: If the owner or iritended c�ntractor are uncer#ain as to what-19censing�requirements may apply�for the
intended work, they are aclvised to cantact the Pasco County Building Inspection Divisian—Licensing.Sec#ion at.727-847-
8U09. Furthermore, if the owner has hir'ed a contractor or contractors, he is-advised�to have'tfie cont�actor(s)�sign
partions of the °cont�actor Black" af this application for which they will be responsi6le: If you, as the owner sign as #he ,
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting�privileges'in Pasco�=
Gounty. �
TRANSPORTATION IMPACT/UTILITIES IMPACT APJD RESOURCE RECOVERY FEES: The undersigned understands �
that Transportation Impact Fees-and Recourse Recovery Fees may apply to the construction of ne�nr buildings, change of
use in existing buildings, ar expansion of existing buildings, as specified in Pasco County Ordinance number 89-07_:and:
90-07, as amended. The�:undersigned also understands, that such fees, as may tie due, will"be identified at the time4of
permitting. tt is further undersfood that Transpartation Impact Fees and Resource Recovery°Fees must be paid�priar-;ta,.
receiving a "certificate of occupancy" ar final power release. If the�project does not involve a certificate af occupancy or
final power release, the fees must be paid prEor to permit issuance, Furthermore, if Pasco Caur�ty WaterlSewer-Irrtpact
fees-are�due, they must be paid prior to permit issuance in accardance with applicable Pasco:,County ordinances.'�
GONSTRUC710N LIEN LA1N(Chapter 71-3, Floricla Statutes, as amended}: If valuation of work is$2,500:40 or m'ore, f
certify #hat 1, the applicant, have�been pravided with a copy of ttie "Fiarida .Canstruction "Lien Law Homeovmer's.
Protection Guide" prepared by the Flarida Department of Agriculture and Consumer Affairs.- -If.the applicant is�someone
other than the"owrte�', 1 certify that 1'have obtained a copy of the abave described documenfand-promise in good faith to
deliver it to the"owne�' prior to commencernent. �
CONTRACTOR'SlQWNER'S AFFIDAVFT: I certify thaYall the inforrnation in this application is accurate arid that ail�work
wiH be done in compliance with ait applicable taws regulating constcuction, zoning 'and land development: Applieation:is
hereby made to abtain a permit to do wbrk and installation as indicated. ! certify that na work or installation has
cammenced priar ta issuance cif;.a permit and that a(I work wilt be performed to meet standards af aH (aws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that 1 understand that#he regulations of ofher governrnent agencies may apply to the intended wark,,:and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include bu#are nat limited to:
-, Department of Environmental Protectian-Cypress Bayheads, Wetland Areas and :Ernironmentally Serisitive
Lands,lNaterM/astewafe"r Treatment.
- Southwest F'lorida Water Management District-Wells, Cypress Bayheads, Wetland Areas, AI#ering
Wa#ercourses.
- Army Corps of Engineers-�eawalls, Docks, Navigable Waterways. �
- Department of Heaith & Rehabilitative ServiceslEnvirortmental Health Unit Wells, 1Nastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federa{Aviation Autharity-Runways. ;
I understand that the following restrictions apply to the use of fill: p,
= Use af fi11 is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understoad that a drainage plan addressing a
"compensating volume° will be submitted at time of permitting �nrhich is prepared by a professional engineer
licensed by the State of Flarida. , i
- If the fill material is to be used in Flaod Zane "A" in connectian with a permitted building using sterri wa!!
constrtictian, 1 ce�tify thaf fill will be used only#o fill the area within#he stem walL ;
- If fill material is to be used in any area, I certify that use af such fill will not adversely �ffect adjacent
properties. If use of fill is found to adversely affect adjacent-properties, the owner may be cited for violating
" the conditions of the building permit issued under the a#tached permit application, for lats less than one (1)
. acre which are elevated by fi!!,an engineered drainage plan is required. �
If!am #he AGENT FOR THE OWNER, ( promise in good faith to inform the owner af the permitting conditions set forth in
#his affidavit prior to commencing constructian. I t�nderstand that a separate permit may be r�quired for electrical work,
plumbing, signs, wells,.poots, air conditioning, gas, or other installations not specifically included in the applicatian. A
permit issued shall be construed to be a license to proceed wi#h the work and not as au#hority to vialate, cancel,"alter, or
set aside any pcovisions of the technical codes, nor shatl issuance of a permit prevent the BuiEding Official from thereafter
requiring a carrection of errors in plans, construction or violations of any codes. Every permit issued�shall become invalid
unless the wark authorized by such permit is commenced within six�months of permit issuance, or if work authorized by
the perrrtit is suspended ar abandoned fara period of six(6)months after the tirne the work is,�commenced. An e�c#ensian
may be requested, in writing, from,the Building Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extensian. If work ceases far ninety{90}consecutive days, the job is considered abandoned=
WARNING TO OWNER: YOUF2 FAILURE TO RECORD A NOTlCE OF C�?MMENCEMENT MAY RESULT IN YOUR
PAYING TWtCE Ft3R IMPROVEMENTS TO YOUR PROPERTY. tF YtJU INTEND TO OBTAiN FINANCiNG,CQNSULT
-►JJI!lTH-�dJlJ1�-I.END�R_�R.AIV_ TTORNEY BEF.ORE RECORDING YOUR N TICE O �COMMENCEMENT. '
F�i3RIDA JURAT(F.S.117. ) — - --
�
4WNER OR AGENT CONTRACTOR "�
Subscxibed and swom to(or affirmed)before me this Subscribed and sworrt ta{or affirmed}before rrie th�s
bY 'I?` ~- �
Who is/are personally known to me or has/have produced Who is/ar rsona �T nown to me or has/have produced ,
as iden�flcation. as identification.
'�
Notary Pubtic G� Natary Public
Commissiort No. Comm s ' Mo.
:r,v�•a.
_. E� . �
Name of Notary typed,printed or stamped - Name af Notary typ �tf:kpt;s�gt� Si����F 15ti�+l:-
-" �.* `. = c.� ecember 12, ;n�
,;^��:,;�:o<i �-�ires D , .
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