Permit Roof 730 Bonita 2011 PY
N ,.. CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 11- 00002492 Date 8/15/11
Property Address 730 BONITA RD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5100
Application desc
Reroof
Owner Contractor
HELMLY KATHERINE C BRANNEN ROOFING, LLC
730 BONITA ROAD 1024 PEBBLE RIDGE DRIVE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32220
(904) 813 -4967
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee . . . 80.00 Plan Check Fee .00
Issue Date Valuation . . . . 5100
Expiration Date . . 2/11/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 80.00 80.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 84.00 84.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
(� 1
Job Address: '30 60i\ii-A Permit Number: 7/ 24/ --7
Legal Description Parcel #
Valuation of Work $ 6 100." Proposed Area of Sq.Ft. Sq.Ft
Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing /pro osed structure(s) (circle one): Commercial Residentia
If an existing structure, is a fire sprinkler system installed? (Circle one es No N /A
Florida Product Approval # fir-- t o t ?—` f . I
For multiple products use product approval form `�
Describe in detail the type of work to be performed: ( 41404 (144$ - k i{'1 A « u rh (_ 5 A i A (e j'
Property Owner QQ Information:
Name: YA heir1r1C C He]n� Address: 1 3t7 Uani +a
City q-OAL44 L kilt h State FC.Zip 3 Z/7.-3 3 Phone ° t'D'-/- - 7133 • 3(0
E -Mail or Fax # (Optional)
Contractor Informmation: �`
Company Name: f`7 'l 1(),{crnl kt)'f l �1�j U C Qualifying Agent: ' qO IJI ((f 6 st,�(
Address: 1f) 2 / c f . (�eob It Pack r City TAY Sta i%L- Zip 3 Z4-2-'
Office Phone q D(f- ( 3 `4-( %'7 f Job Site/ Contact Number ti- 91 - if % Fax # 781-e( •�
State Certification/Registration # CCC 1 9 b b la
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time a /ier
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Healers,
Tanks and Air Conditioners, etc.
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.
1 hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
i
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Signature of Owner V v Signature of Cont for ''
Print Name , ,
.e u n t. Q .€� Print N ame 1 i ii . , a06,
Sworn to and subsc ibed before me
Fir ` _. DEBORAH AMANDA WHITE _
Sworit#444 subscrib mMY •• ,'
this 6i,(- Day of
� , 20 � ( this Day of . niay21,2o X20 /I
1 �d>IlDlliii�
AI I e . ter!♦ I'
No a "ub�ic Notary Public
, .:g ; MIRANDA T. SKELTON M�"' /, Revised 01.26.10
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im :. Commission # DD 986198 Z S 7 J 4 3
� Expires April 27, 2014
'' ; •7.:th `' Bonded TMU Troy Fain Insurance 800- 385-7019
Doc g 20 ;1177o, 4 UR SK 13666 Rage .4:-
Number Pages: 1
Recorded 08 15 2011 at 09:36 AM
JIM PULLER CLERK CIRCU■T COURT DUVA
COUNTY
RECORDING $10 00
- NOTICE OF COMMENCMENT
State of Florida PERBMIF
6e „
Ti e r gdersigaed herby Worsts all concerned that haproveasods mall be node to certnit
real property, and in aearrdanee midi seethes 713.13 et the Flowida Statses, do fellowirg
information is stated m the NOTICE OF COMMNCMENT.
Description of property . _ . 1 5. 6 i...-1 a i i' . C i) _ 1 • —
Geseral description of iumprovonent _BMW
- Owner - K6MI.Z.virk , el Irv\ 11 .
Address 1?, 6 i i...c.
Owner's interest in site of the iniprarent SOME
F�'9 Tide holder Walther than owner)
Nam SAME
Address SAME
Contractor DRANPIAPI ROOFING LLC
Address 1.7.41,21181.1CREDIGNIPRIVEJACKIM
Surety Cif any) NONE
_Address NIA Anseseet of Bond SIVA
- --
Name of person within the State of Florida designated by owner rpm whom norm or other
doormats may he serve& I/ 1 1
t,z).-riv_iloc let vv-Nlii -- -
.., -
Phone ......-
r -
Address 1 3 C nc,,, I r
In adoration to binthersel4 owner designates the foilinting poem to receive a ow of 011C Lerair"s
Nader us provided ha Section' a 713.13(1) (P), Florida Stalintes. (Fill in at Oweees option).
Name SAMS
Address SAME
TEM SPACE 18 FOR RECORM/rS USE ONLY
My Commission limping: \<aAheri,44) C kii
OVIRSOCIS IPRIPITEDNAlte
I
lia . -t. • V
Signature
M
e s,:gulli c, IRANDA T. SKELTON - -
........... T)t..,4 44r a 1 , , _ • _ ctx1 0
4: i Commission # DD 986198
Expires April 27, 2014
*KW Bonded Thru Troy Rim Insurance 800-385-7019
------------------
08/15/2011 MON 9:15 FAX 2002/005
Sales Price: $96,000.00
This Warranty Deed
Made this 12th day of August,2011 A.D.
by Larrry Randall Schrecengost AND Sharon Bradley Schrecengost, his wfe
hereinafter called the grantor, to
Katherine C. Helmly
whose post office address is:
6321 Raw Hyde Trail North, Jacksonville, FL 32210
hereinafter called the grantee:
(Whenever used herein the term "grantor" and "grantee" include all the parties to this instrument and the heirs, legal
representatives and assigns of individuals, and the successors and assigns of corporations)
Witnesseth, that the grantor, for and in consideration of the sum of $10.00 and other valuable
considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases,
conveys and confirms unto the grantee, all that certain land situate in Duval County, Florida, viz:
Lot 4, Block 1, Royal Palm Unit 1, a subdivision according to the plat thereof recorded at Plat Book 30, Pages
60 and 60A, in the Public Records of Duval County, Florida.
SUBJECT TO all covenants, conditions, restrictions, reservations, limitations, easements and to all
applicable zoning ordinances and restrictions and prohibitions, the reference to which shall not operate
to reimpose same, imposed by governmental authorities, if any, and taxes for the current year.
Parcel Identification Number: 171094 -0000
Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise
appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee
simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby
fully warrants the title to said land and will defend the same against the lawful claims of all persons
whomsoever; and that said land is free of all encumbrances except taxes accruing subsequent to December 31,
2010
In Witness Whereof, the said grantor has signed and sealed these presents the day and year first above
written.
Signed, se:l crnd..deiivvered in our presence:
..HO'!AS . SANTORO
-Witness m r Larrry Randall Schrecengost - seller
rry Schrecengost ;i
Lauri Maynor
- Witness Sharon Bradley Schrecengost -' "4ou«
1719 Aston Hall Drive East, Jacksonville, FL 32246
State of Florida
County of Clay
The foregoing instrument was acknowledged before me this 12th day of August, 2011, by Larrry Randall
Schrecengost AND Sharon Bradley Schrecengost, his wfe who is personally known top o y/v has produced
a drivers license as identification.
' '
' THOMAS C. SANTORO '
PREPARED BY Trina M. Larsen �: :R` Commission # 918993 ' Notar
Expires October 3 1, 2013 Public
_� � =w' 3
RECORD & RETURN TO: z ; ionamo t,. -” Troy Fain tnwan imonai inin Print Name: Thomas C. Santoro
Thomas C. Santoro My Commission Expires: `-
1700 Wells Road Suite 5
Orange Park, Florida 32073
(904) 278 -8713
File No: 11 -17126
08/15/2011 MON 9:15 FAX 0001/005
Thomas C. Santoro
1700 Wells Road, Suite 5
Orange Park, Florida 32073
(904) 278-8713 Phone
(904) 278-8768 Fax
..„ .
TO:
;
From: Trina Larsen trinaAsantoro-law.eom
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08/15/2011 MON 9:15 FAX 12003/005
1 OMB Approval No. 2502 -0265
; ' A. Settlement Statement (HUD -1)
B. Type of Loan __..__...-.----.--_-_-.-.-
r--- i 6. File Number: 7. Loan Number; 1 B. Mortgage Insurance Case Number
t_ [ FHA 2.,r. RHS 3 CONY. UNINS. •
•
1 11 -17126
4, f VA 5. j CONV. INS.
•
• C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside 1
the closing; they are shown here for informational purposes and_ are_ not included in the totals. -� I
D. Name & Address of Borrower: 1 E. Name & Address of Seller: F. Name & Address of Lender:
Katherine C. Helmly 1 Larrry Randall Schrecengost and Sharon Larry Randall Schrecengost and Sharon
16321 Raw Hyde Trail North Bradley Schrecengost Bradley
Jacksonville, FL 32210 i 1719 Aston Hall Drive East
i Jacksonville, FL 32246
G. Property Location: I H. Settlement Agent: I. Settlement Date:
730 Bonita Road ;Thomas C. Santoro, Esq. August 12, 2011
Atlantic Beach, Florida 32233 i 1700 Wells Road, Suite 5
Duval County, Florida Orange Park, Florida 32073
904- 278 -8713 fax: 904 - 278 -8768
j Place of Settlement:
1 Thomas C. Santoro, Esq. 1
1700 Wells Road, Suite 5
{ Orange Park, Florida 32073
I Phone: (904) 278 -8713
J. Summary of Borrower's Transaction [K. Summary of Seller's Transaction
100. Gross Amount Due From Borrower: 1 400. Gross Amount Due To Seller: - -_ _
101. Contract Sales Price 96,000.00 401. Contract Sales Price
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower (line 1400) 3,047.00 403. ___
Adjustments for Items Paid by Seller in Advance: Adjustments for Items Paid by _Seller in Advance:
106. City / Town Taxes 406. City_! Town Taxes
107. County! Parish Taxes 407. County/ Parish Taxes
108. Assessments 408. Assessments
120. Gross Amount Due from Borrower: - 99,047.00 420. Gross Amount Due to Seller: 96,000.00
200. Amounts Paid by or in Behalf ofBorrower: 1 500. Reductions in Amount Due to Seller: __
201. Depositor Earnest Money _ 501. Excess Deposit (see instructions)
202. Principal Amount of New Loan _ 96,000.00 502. Settlement Charges to Seller (Line 1400) �_ 0.00
203. Existing Loan(s) taken subject to _ • 503. Existin. Loanjs) taken subject to .- .__ - _.____.__...
204. Daily interest credit _..__ 504. Payoff of First Mortgage Loan
205. -_.._ 505. Payoff of Second Mortgage Loan
206. x_506. Purchase Money Mortgage __- ______• -_
207. i 507. Seller Financing 96,000.00
_____..�... - __ - -.-
Adjustments for Items Unpaid by Adjustments for Items Unpaid by Seller:
210. City / Town Taxes 510. City I Town Taxes
211 County / Parish Taxes Jan 1, 2011 thru Aug 11, 1,459.79 511, County ! Parish Taxes Jan 1, 2011 thru Aug 11, 1,459.79
2011 2011
- 212. Assessments 512. Assessments
220. - Total Paid by / for Borrower: - T 97,459.79 _ 520. Total Reductions in Amount Due Seller: 97,459.79
-- - --
300. Cash at Settlement from / to Borrower: 600. Cash at Settlement to / from Seller:
301. Gross Amount due from Borrower (line 120) 99,047.00 i 601. Gross Amount due to Seller (line 420) 96,000.00
302. Less Amount Paid by /for Borrower tie 220) 97,459.79 ? 602. Less Reductions Amount due Seller (line 520) 97,459.79
303. Cash From Borrower: $1,587.21 603. Cash From Seller: $1,459.79
,
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data.
This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.
No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information
during the settlement process.
Previous editions are obsolete
.......
Page 1 of 3 _ - - HUD -1
August 11, 2011 11:47 AM
08/15/2011 MON 9: 16 FAX 1004 /005
Settlement Date: August 12, 2011 File Number: 11 -17126
L. Settlement Charges ; f - Paid Paid from Paid from
700. Total Sales / Broker's Commission: I Borrower's i Seller's
Division of Commission (line 700jas follows f Funds at i Funds at
701. Settlement ' Settlement
702.
703. Commission Paid at Settlement
800. Items Payable in Connection with Loan: _ W - - - --
801. Our origination charge (from GFE #1 -� -
$0.00
802. Your credit or charge (points) for the specific interest rate chosen (from GFE #2) I
$0.00
803. Your adjusted origination charges (from GFE #A
804. Appraisal Fee
805. Credit Report I 1
806. Tax Service _ j
807. Flood Certification - -- j
900. Items Required by Lender to be Paid in Advance: r -- ---
901. Daily interest - NONE (from GFE #10)
902. Mortgage Insurance Premium _ - (from GFE #3)
903. Homeowner's Insurance (from GFE #11) I i _
1000. Reserves Deposited with Lender _ __
1001. Initial deposit for your escrow account _ (from GFE #9) I -
1002. Homeowner's Insurance I i ___._.___.__ _ .
1003. Mortgage Insurance .' i
1004. Property Taxes
1100. Title Charges: . - 1 - 1 - -
1101. Title services and lender's title insurance - (from GFE #4) I 1,050.00
- Closing Fee to Thomas C. Santoro, Esq. $375.00 j
- Title Search to Old Republic National Title Insurance Company $100.00
- Simultaneous Issue to Thomas C. Santoro, Esq. $150.00 I
- Attorney Fee to Thomas C. Santoro, Esq. $200.00
- Document Preparation Fee to Thomas C. Santoro, Esq. - -_ $200.00
1102. _Settlement or Closing,f, _.^ $ I_..___.___..__._..____.__..
1103. Owner's Title Insurance (Old Republic National Title Insurance Company) (from GFE #5) 1
(Risk Rate Premium: $552.00)_ - _ 745.00 I
1104, Lender's Title Insurance (Old Republic National Title Insurance Company)
to Thomas C. Santoro, Esq.
- Lender's Premium $25.00
1105. Lender's Title Policy Limit $96,000.00 I 1
1106. Owner's Title Policy Limit $96,000.00
1107. Agents Portion of the Total Title Insurance Premium $539.00 i
1108. Underwriter's Portion of the Total Title Insurance Premium $231.00
1200. Government Recording and Transfer Charges: ( -_
1201. Government Recording Charges from GFE #7) 52.00
1202. Deed $17.50 Mortgage $34.50 Releases $0.00
1203. Transfer Taxes (from GFE #8)T 1,200.00
1204. City /County tax/stamps Deed $0.00 Mortgage $0.00 _ - _ __
1205. State tax/stamps -_ Deed $672.00 _ Mortgage $336.00
1206. Intangible Tax
to Simplifile _. -___-_ $192,00 _
1207. Other Tax 2 1 r----•.---- -- -___
1300. Additional Settlement Charges:
_ 1301. Required services that you can shop for _� �_ (from GFE #61_, 1
1400. Total Settlement Charges (Enter on line 103, Section J and line 502, Section K) $3,047.00 $0.00
1 have carefully reviewed the HUD -1 Settlement Statement, and to the best of my knowledge and belief, it is a true and accurate statement of all
receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of HUD -1 Settlement
Statement.
i ,: i - t ��
f .
Borrower: _ _ - ,: - - Seller: -- -- - --r-
Katherine C. Helmly Larrry Randall ' S chrecengost
Sharon Bradley Schrecengost
The HUD -1 Settlement Statemetch -,6
-h'Sve prepared is a true and accurate account of this transaction. f have caused or will cause the funds to be
disbursed in accordance with s ateinent.
Settlement Agent: _,:-"Y.---;" Date: August 12, 2011
THOMIAS NTORO
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can
include a fine and imprisonment. For details see Title 18 U.S. Code Section 1001 and Section 1010.
Previous editions are obsolete Page 2 of 3 HUD -1
August 11, 2011 11:47 AM
08/15/2011 14014 9:16 FAX 0005 /005
Settlement Date: August 12, 2011 File Number: 11 -17126
Compaason of Good Faith Estimate (GFE) and HUD Charges
Good Faith
Charges That Cannot Increase I
1 HUD Line No. Estimate HUD
Our origination charge # 801 _ — 0_00 i 000
Your credit or charge (points) for the specific interest rate chosen # 802 0.00 ( 0.00
Your adjusted origination charges # 803_ _. -.. 0.00 _ _
0.00
Transfer taxes — .__•.____..,_______ #1203 1 0.00 I 1.200.00
Good Faith i " ..- �`__
Charges That in Total Cannot Increase More Than 10% HUD Line No. HUD
Estimate j __
Government Charges #1201 I 0.00 52.00
..
Total i ...._._.. - 52.00
Increase between GFE and HUD Charges 52.00 100.00%
Good Faith
Charges That Can Change HUD Line No. —�- , HUD
Estimate _
Initial deposit for your escrow account #1001 I 0.00 i 0.00
Daily interest - NONE ! # 901 I 0.00 0.00
Loan Terms
Your initial loan amount is
11'96,000.00
Your loan term is 30 years
' i Your initial interest rate is 1 4.5 %
Your initial monthly amount owed for principal, interest, and } $486.42 includes
I any mortgage insurance is I [ X ] Principal
' [ X] Interest
[ 1 Mortgage Insurance _,
Can your interest rate rise? [ X ] No. [ ] Yes, it can rise to a maximum of %. The first change will be on
and can change again every after . Every
I change date, your interest rate can increase or decrease by %. Over the life of
1 the loan, your interest rate is guaranteed to never be LOWER than % or
HIGHER than %.
Even if you make payments on time, can your loan balance j [ X ] No. [ 1 Yes, it can rise to a maximum of $ .
rise?
Even if you make payments on time, can your monthly ; [ X ] No. [ 1 Yes, the first increase can be on and the monthly amount
amount owed for principal, interest, and mortgage I owed cart rise to $ .
insurance rise? I The maximum it can ever rise to is $ .
1 Doesyour loan have a prepayment penalty? [ X ] No [ ] Yes, your maximum pre ment penalty is $ _
Does your loan have a balloon payment? [ X ] No. [ ] Yes, you have a balloon payment of $ due in years
on
Total monthly amount owed including escrow account [ X ] You do not have a monthly escrow payment for items, such as property taxes
payments and homeowner's insurance. You must pay these items directly yourself.
[ ] You have an additional monthly escrow payment of $ that results in
a total initial monthly amount owed of $ . This includes principal, interest,
any mortgage insurance and any items checked below:
[ ] Property taxes [ ]
[ ] Flood insurance ( 1
Homeowner's insurance ( 1 l
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Previous editions are obsolete --
Page 3 of 3 ���
— _
HUD -1
August 11, 2011 11:47 AM
08/15/2011 MON 9:48 FAX 0002 /002
Recorded Electronically
OR BK X.s „5 /6 w. Rage(s) .....1e--- ..
Sales Price: 496,000.00 " County, Florida
Date: &/!/2 rs / , Time: /'% 6 7l- :
f
This Warranty Deed
Made this 12th day of August,2011 A.D.
by Larrry Randall Schrecengost AND Sharon Bradley Schrecengost, his wfe
hereinafter called the grantor, to
Katherine C. Helmly , A Single Woman
whose post office address is:
hick ikmk lixkogiliamaiHt kX 22)W 730 Bonita Road, Atlantic Beach, Fi.
hereinafter called the grantee: 32233
(Whenever used herein the term "grantor” and "grantee" include all the parties to this instrument and the heirs, legal
representatives and assigns of individuals, and the successors and assigns of corporations)
Witnesseth, that the grantor, for and in consideration of the sum of $10.00 and other valuable
considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases,
conveys and confirms unto the grantee, all that certain land situate in Duval County, Florida, viz:
Lot 4, Block 1, Royal Palm Unit 1, a subdivision according to the plat thereof recorded at Plat Book 30, Pages
60 and 60A, in the Public Records of Duval County, Florida.
SUBJECT TO all covenants, conditions, restrictions, reservations, limitations, easements and to all
applicable zoning ordinances and restrictions and prohibitions, the reference to which shall not operate
to reimpose same, imposed by governmental authorities, if any, and taxes for the current year.
Parcel Identification Number: 171094 -0000
Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise
appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee
simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby
fully warrants the title to said land and will defend the same against the lawful claims of all persons
whomsoever; and that said land is free of all encumbrances except taxes accruing subsequent to December 31,
2010 •
In Witness Whereof, the said grantor has signed and sealed these presents the day and year first above
written.
/ '
Signed, eiileq�,ancj..cIelivered in our presence:
r
4.—' --- THOMAS C. SANTORO . Randall Schrecengost senor
- Witness
e � ' / mil ; �: , . t t ' " ._.
Laura Maynor - witness Sharon Bradley Schrecengost)' - -Seller
1719 Aston Hall Drive East, Jacksonville, FL 32246
State of Florida
County of Clay
The foregoing instrument was acknowledged before me this 12th day of August, 2011, by Larry Randall
Schrecengost AND Sharon Bradley Schrecengost, his wfe who is personally known to , e o .who has produced
a drivers license as identification.
aawyi..aomw,. ,,:
, „0: , ,,, THOMAS C. SANTORO r' ,/ I �' _ _
PREPARED BY Trina M. Larsen : *= Commission # r 3 , 201 3 Notary public W
• ?; ,• . �: Expires October 31, 2013 Y
'' ,, " a r V. 9oreok Tin Troy F Insurance $0°-38$.7014
RECORD & RETURN TO: ,,,,,,,,�, Print Name; Thomas C. Santoro
Thomas C. Santoro My Commission Expires:
1700 Wells Road Suite 5
Orange Park, Florida 32073
(904) 278-8713
File No: 11 -17126