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<br />11lil nHAHCIHG ITAn:IUHT io ,.._ed 10 . 'ili.. Ollie.. No, ol Addi.iDMI <br />(or fiIilII .........1 .. .... V....... Cetn-m.l Coodr. Sh.th Prn....ed: <br />!. IhIMer/II (""1 K_ r""I' ud A.doINII(_I. ~. Socund 'a",(in,: Hamel') and Addr...(..): <br />P'A"'f.Sf/"'J1/1f4"VIAI It/. ./~IJ4"A HIl'W4S...,...IIEAT"II/~ "" A Ie. <br /> <br />Rr. " "Box .z.....3 P.I>.." 12.77... <br />6A~l> %s"..,D/ ~. '880 f .-JO ZS'A#ll>, #8. "g.eo~ <br /> <br />Soc...Security No. ~'7-74 -5' .:a. 3.z. Fed_ 1.0. No. .of7 -a4 a~Z:7A <br /> <br />~.(I~~L:f:~ <br />4. For Fili... 0IIic..: 1i_. Da.., <br />No.. Filial 01&.. <br /> <br />88-. 103126 <br /> <br />1 <br /> <br />5. 1'1Ie FilllOad.. Ik-..'c-m doe Followi", 1fpeo (. II_lor ....perlJ: <br />IfH~,.J"<.C -It1!UR. CO,",PI ~'Q"'~~ 1A}1.,..1-I PU<'"r tMDIt~ <br />'-N3-r~"IiO.AT"" ~"'f': IJ ~J( zA.3 <br />" (j,'''''''D ~ """'''1 ,Ie. , B Bot <br /> <br />QI'roc"'- <br /> <br />o Product. ol lb. CoUal..a1 ar. AI.o c-..ed: <br /> <br />6.J!(To b. R.-.dcd in R.... <br />10.... Monp.. Rcconb <br /> <br /> <br />$u1JDltllfl'# <br /> <br />e. N~::~ ol ll1#LfflAl4lEzeecA PAU.L'SfMI <br />Own..(.): ) <br />9. AniIlflCClI) olSc:cuml 'any and AddNll(.., <br /> <br />Hall County <br /> <br />10. 11IiI "_I is liIed wilboul ,~d"'I.'1 li.lUllute 10 p..r.... a leanil, inl..... in tvlIcI....1 <br />- \..... fXlillD) <br /> <br />o ....... lubjm 10 . I...,n", in.....1 in .no,..... jurildi....n when il ..a. brouabl in.o Ihi> Sla... or <br />o ..Iaici. io ~ .r 1M loIlowi.. dooaibcd orilinal coII......1 ..hich .... pur.c.ed: <br /> <br />Pint Pederal ....... &. I.a <br />A-x:I.aIoD 01 Uaco.... N.. <br />13 ah &. N Scnec <br />IJacolo, HE Ci8508 <br /> <br />By !ftbn'4_ fhui4r,,~ n/~/i.lt9~ <br /> <br />8."..._(1' ol o.bIO<(') <br /> <br />~~ <br />Iy ...4l ....-.c./ <br />St..... r red Pan, <br /> <br />FORM 101 <br /> <br />(1) FILING OFRCER COPY <br /> <br />"-;1"'''" "':-'-"'-'-'~--"''"''''''~'''-''!"'Jr.)r,.'r.'.J!G<\.'P.'''''~,l'!}i~~l',,::"~n'!'.I;1,$:~~~,~""'~: <br /> <br />--- -. ~.---,,--.....-~ ";L<:-= <br />