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<br /> �,I.I117 S�)F1CF, �.UI' USE: I)y C,Icrlc c�l�Llic; t�:ircuil: C'vurl. ��iil��. �
<br /> . � �Q�I�I G� U�' C 4 I1�[i�[���I G��I�I�I`�'T � .
<br /> Siale of f=lorlcl� • . � . Permit l��uti�iLier . ----
<br /> C,ouiily of I�Illlsl��r�uc�l� .
<br /> "I�he tin�lersl��ned I�ereLiy��jlves riollce Ilial l�r����'ovel�7e��ls Y�III be,�nRCle [o cetlalit r�al ��ro��ei�ly; �iid li� ��ccorcl�nce tvlli� ,
<br /> 'socllo�i 7'1;3,'13 of ll`io 1=loiida Staluos, lhe followln� lnformallon Is provided lil !I�e I�IOTICE Of-COIv11NEl'�ICElv1L=1'JT.
<br /> . , . . . ,
<br /> �I. , � Le��l Des�il��llon of�iro��erly.(Incluc.le slre�e��cJr.iress, If�v�llal,l'e) ����{� �r'1-/�f t e (�o� `� _.— .
<br /> � • '� �5 :c.. 71���.C� ��- � '� { . S - ' /rC .`l� �.i41� C, r� S . t�ir� U �`"',�
<br /> • �.c..0� �'� Z ��c SeJ� � �r�a�� i.2 � �S 2G l�21 k�:x C� �r� � .. .S �r � Fk� � 2�,���` � � -
<br /> � ' � ��61,'< t�r�u
<br /> w��s�z �a.,�,�y ro'1
<br /> 2. � Gei�el'al descrl��llolt oPllti��l'ovel»enl5: rUcw '�,��,,,�,,:�� ��;�,� �i1�111�•c•r �ne\c�s�re .__._
<br /> . 3�. Owr�er 1'�I�ir�e �t «... �-�wv�- . --- _.
<br /> • Owner/1cl�:lress: � � <�„�., �rCC __
<br /> �I�. Uwi•ter's Ir�le�'esl�In slle; (�w���'
<br /> 3c. 1=ee Sirn��le '1�illo I�olcler (oF alltel� ll���� oWi�er)__ j��P� �� •
<br /> ' /-1cJdress;___ �.l�A • . . ----
<br /> !I, C;o��lraclor I�iame: - l�sc�t �� � �^ ^ ,
<br /> , : �l�C�f�55:. �l�J l�i'�'�1:�• '�vCS�� ?���'ri\� l�hnno fJ�����hor_�L� ��.�7`�/ --•-•-
<br /> (
<br /> J. ' SUI'P�y I�I�ine`._ � ��� ' • Ainounl o(boncl: .
<br /> . �ciclress: n�1/�! Pho��e I�lu�t�be�': ' �
<br /> G. Loncler I�laine: 1� � ' � '
<br /> 1� Conl�cL'
<br /> � /�dCll'esc; PI101�B NU111I)BI': . — ----•-
<br /> , „�. '
<br /> �I. I�BI�5�11 WII�IIIt IIIB S�'l�B DF rIOfICIF CI86IellE1�'BCI I7Y DWIl81'll�)DIl WI.IOnI f1DLIC�BS 01'D�I1B1'CIOClIIT1PIlIS'ITI�y VD JOIVQ[I �:y
<br /> , prov�clod by 5eolloi7 7'f 3.'13('I)(a)7, riorid� Sl�luos. ' •
<br /> . � .
<br /> I�IFl�.:no:_. ' �`11 ' � .
<br /> . , , , /lciclre�s; •
<br /> . . . � Pl�oi.�e I��LI111beC: . ---�.
<br /> t1, lii �dcllllor� lr� I�hnself, Owi�er cleslgnales l�ie �ollowl�iy pe�'son lo recelve R ����y of lhe Lle��or's I�dollee �is pravlclecl In
<br /> Secllor� 7'13.'13('I)(b), 1=lorida 5lal'ules. ' . • . .
<br /> . ly�rr��o:_ N'� . • /lddress: � ' ' .
<br /> 1 • . .
<br /> �. E>��,>Ir�flo;�i dflle of l�lollce c�( Co�ti�t�e��cel�le��l (axj�l�'allon d�le Is oite ('I) yeai' f�'aln cl�[e vf��ecordln[� Unit�ss Er
<br /> • dl(f��'eril��le ls speclflecl). � . , �
<br /> . .
<br /> . � .
<br /> • -, - . • ------
<br /> . . � I�nal�.ire oP Owner — . . .
<br /> • S'I�/\l�l= OI= rLORIL�n • ' ' � ,
<br /> COUI�•1'1'Y U1= I•IILLS[30RbUC;I•I •
<br /> -I'lie fol'c��oing Inslruiii�iilov2s �elutowleclyer.l bA(o1e ii�e lhis� e
<br /> . . �dalo oP � ��
<br /> -- � ��'�����\U.� � 'u.�-� . . . �.��-1�., �>Y .
<br /> ,�`/ t� �wltq (Is)(�ro) �:��rsonE�lly
<br /> I;nown lo ine ur �r.ocluc�d _ �f�(D�cJ—'��a�7-� �QC/^ ,
<br /> � �� �s ider�lilicalioii, wl�o clld/dicl riol laltr� �ii onl,li.
<br /> � �} (UilvP�•'s Ll�;eiisef?)
<br /> SI.ria i�'e�-hlol� - il�lic: — �� i c'.RICKLAND
<br /> . 09CL£83 ' AW � MY COM?�IiS;�,.;N b EE837060
<br /> �v1y Con•tmisslon Cuplres
<br /> aNY .lS'"1 13H V21',�1�r �'eans� e�iRFS:s�r>r�Zo,zo�6
<br /> . , Coit�inl i — •-----•
<br /> (!1 co��y uf��;y boriJ �nus( be oLlr�cliecl �(lhe Iln•i� of recorcleUon of Iliis l+lollr,c� oF Coniniei�c�it�Aiil.) '
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