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<br /> 7h��STATEti�ENT�s prese�tad�o o i,.•ngof4:ce.4�.�,L�g p,,.�ua�• o*he U� +=rr� Commora�a� Codo: 3.Mer„���y d�rc!�F a�rS: _
<br /> 1.Oebto�(s�(lns•Nasne F,n+� un1 address��s) 2.Secu.�i Pa�+rt�es�and aad.ess+cst F,�. F�h�g OFf�ter', ��n4
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<br /> Sohn R. & Barbara J. fi THE EQIJITABLE LIFE ASSURANCE i�t 'i�t Ct�EJli3Y" .Rti�.OFFIEE
<br /> RFD #I � SQCIE'TY OF THE UPiIT�D STATES �� ���' � ,��Rk l�
<br /> �iro r 5824 � P. O.Box 2926 _ AAR10RlE fll0 i.1 TY ClERk i
<br /> �,��.'j���� ; Over2and t'ar, P.S fi62Q1-1326
<br /> Sociaf S'�ecurity No. Sn7-2��—�475 � Federal I.D.No. 1� 5570fi51 � .� � ��
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<br /> q,This statemenr ro{en to ong�ncl F��o�t.�q Stattmc�t eo��ng F�•e No. �,�1,7 �
<br /> F�led w�rr. Hall Countp Clerk �o.� F�led June 25 Z971 TEM '
<br /> 5.���j�upt�p�, The orig�nel l+nvn=�r+g sto'emer.r betticcr the�c*ego,�•q De5*:�an� Sec�•ed?o•*y,bea•�ng filc n�mSer shhwn e ve,sf�til) �ffeef��e.
<br /> 6.��ltnunOfiOn. Securod party no Ice�er c�o�rns: s�co•�+y ��'erest u-•t�����f�r�"=+r.� st7*emer•Eeor�ny f�ie m;mher snewn aM��e.�
<br /> 7,��SicjtmCtit. T6e sacwed porty�� t�QF.1 4ilJG/ •�^f�r:n:�'g sta!erie�'beenng 61e��:rnFer shown above�c tFr p'epett� dr.screbnd m Item 74 have
<br /> ^ been assigned tc tha ass�g�ee�+.t�ase nama rnd-.da•^-ss a0R^��t„'�ten !a1_
<br /> ' 8.L AnYrtdmRtt. F�nenang �}e�enenr Eecrirg-iilo.�.,mF.ar shuhr oh•�ve,s ca�maew ae se!fo•tF �n Item 10.
<br /> 9.�Release. Secured Pc•tj reitcses rfee �11:-+'r-�l descr.bm.� �•Itern 1�frn �'-r f:�:ncir.g sia�tment bacnrq 4�'ts�trnbar ahown abor�.
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<br /> Cha Zes td. Priace, Assistant Secretary
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