1335 Rose Street WELL-SEPTIC CONVERSION App 02.09.2012 I-
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City of Atlantic Beach • 800 Seminole Road •Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 • Fax (904)247-5805 • http://www.coab.us
APPLICATION FOR ASSISTANCE
WITH CONVERSION FROM
WELL AND SEPTIC TANK TO CITY WATER AND SEWER
FY 2011-20-12 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
The information requested on this form is required in order to determine your eligibility to participate in this
program. (These funds may be available to homeowners whose incomes are within low and moderate levels
based upon family size and as established by HUD Section 8 Income Limits.) Please answer all questions,
and provide copies of all required documents. (Your information is considered confidential.) Funds for this
program are available only to owner-occupied homes. In the case of a duplex or two-family dwelling, the
property owner must live full-time in one of the two units as documented by a valid homestead exemption.)
Grant funds are limited, and applicants are selected based upon most urgent and serious need and
availability of funds. p
DATE: /
1. 4r
Homeowner Name (s): -‘-`4"4I • 7
2. Address of Home: /3 3S /eac.... ,-;r--
3. Telephone Number: SE'S' . a 4/ (day) (night)
4. Is the person completing this application the Head of Household? yes ❑ no ❑ female ❑ male
5. How many family members live in this house? /
6. Are there people living in this 1 I use with disabilities or special needs? n yes P no If yes, please
explain ‘, t 44/,41,(L- , ' i - frs
7. Number and age of persons living in the household in addition to Head of Household.
Ages 0-5 years old Male Female
Ages 6- 17 years old Male Female
Ages 18-39 years old Male Female
Ages 40-64 years old / Male Female
Ages 65 and older Male Female
8. Water supply is provided by: ESCity Water ❑ Private Well Other
9. Does septic system work properly?,13 Yes ❑ No If no,please explain.
Page 1 of 3
10. Does your plumbing work properly? , Yes ❑ No
If no, please explain.
11. Is there hot and cold running water in your house? Yes ❑ No
12. Do you have a complete kitchen with running water,a refrigerator and cooking facilities?
,.."--'------
13. How many persons are in your family and living at this address?
14. Federal regulations require that we keep track of certain demographic information and the type of
households being served. Please check the appropriate box below.
rWhite,Not Hispanic
❑ African-American,Not Hispanic
❑ American Indian or Native Alaskan
❑ Hispanic
❑ Asian or Pacific Islander
❑ Female Head of Household
❑ Other
15. What is the total annual income(before taxes) of your household? /S O° p
16. Are you on a fixed income such as Social Se rity, S\SI or retirement? ❑ Yes j'No
17. What are your sources of income? CAC" i1
18. Do you own this home? ® Yes ❑ No
If you own your home, please provide a copy of your deed and a recent water or electric bill which shows that
you live att-address. If, .0 re . r ome,j�lease provide a copy of the lease
(--7
ignature of Owner Date
If you have any questions about this application or need any assistance preparing
the application, please contact the City of Atlantic Beach at (904) 247-5817.
The following Income Verification Form must also be completed and mailed or
delivered to:
Community Development Department
City of Atlantic Beach
800 Seminole Road
Atlantic Beach, Florida 32233
Please provide the time of day and day of the week (Monday through Friday) when it would be
most convenient to make arrangements for a ' nsp ctor t with you, and the phone
number where you wish to be called.
Page 2 of 3
. .,
. ,..
MI JOHN R. MOON PLUMBING CO.
Remodels • New Construction • Evening and Weekend Hours
State Certified CFC 019200 '/�/�
- ESTABLISHED IN 1981/7''f --- -,�
--_, -- 23 ____:).
424---- -,
Phone (904) 249-27581\
Customer's
Order No Phone �(
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Na
Date 3/ -�
Name t�•-�--.� -0-A----4—''
Address / S 3 S 4.) s"J�
/d_ey
A.i
ESTIMATE PAID DEPOSIT PD PAYMENT FINAL PMT BAL DUE
0 CASH
0 CHECK#
QUAN. . DESCRIPTION PRICE AMOUNT
e-o}'k / 6/,,, :, v -c ;
C
c
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7-6- j.,:tf 1:/i7.547:4...4.. ,
pA,45. cg,L_cicae ..,_:.c.A4,,e, ,
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is NSU'_-' r ,l
MAR 05 2012
-
by
All claims and returned good MUST be accompanie by this bill. TAX , /
Received TOTAL G3 ,'6N l
ALL ACCOUNTS OVER 30 DAYS WILL BE CHARGED 1 1/2%INTEREST ALL ACCOUNTS OVER 90 DAYS
WILL BE C.O.D.ALL ACCOUNTS OVER 120 DAYS WILL BE TURNED OVER TO A COLLECTION AGENCY
FOR COLLECTION.REASONABLE ATTORNEYS FEES FOR COLLECTION WILL BE ADDED.
a
Pro osal Page No. of Pages
AC/e car- QLe1-,ciaccLA - BILL FENWICK PLUMBING, INC.
State Certification #CFC019174
8245 Beach Blvd.
'c •` JACKSONVILLE, FLORIDA 32216
904) 724-7022
FAX (904) 724-8869
PR1BM TO PH
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)--(0e6,00 aE a� f//
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STREET r JOB NAME
I33s kL '1I .
CITY STATE and ZIP CODE / JOB LOCATION
Atp Bch �3Q�33
ARCHITEC ..J DATE OF PLANS JOB PHONE
We hereby submit specifi tions and estimates for:
C Cidfail aliid 101-WilA t-i-04* ,61-w a 6.2.ailp±
,I3Lh cALet a od ALuk aA,Qom/ (9< Lac ul - i J
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ou_d_ ? -AL L,,,,,F,LM 1 -H1/41__ -- --A__e_e_ W CU Crae./ka
tug._ ryn7„...,,,,ce:ic.2.4,u2._ y_x_c_fL__ 7z0 64_. Izafe__e_x_ dt.31.,(
61,k. ai_ A.Lce:y1,,./nu_,,d. c.3_
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wakt_01. t_cl4 jwo tve_i _4_,() ,
IIIIr lrnpnse hereby to furnish material and labor - complete in accordance with above specificati/ioo`nns, for the sum of:
dollars ($ " �e c ).
Payment to be made as follows: ,¢
(J--U_ U--prk- CerY)LOOLAll material isguaranteed to bepr asispecified. All work to vi completed in a workmanlike Authorized / \/ n /
manner according to standard practices. Any alteration or deviation from above specifications �����T///",,CCC/JJIIIci / i
involving extra costs will be executed only upon written orders, and will become an extra Signature
charge over and above the estimate. All agreements contingent upon strikes, accidents or
delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our Note.This pr0•.OS0l ay be
\orkers are fully covered by Workman's Compensation Insurance. withdrawn by us if not a sept: within days./
-The above prices,
r�CP t�tYtrP IIf rII IIBM�
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
Flint Construction Services
;E2/ • • • • • • • • • • •
1419 Linkside Drive
Atlantic Beach, FL 32233
License# CGC1508003 & CCC1327402
# CAC 1816283 & CFC 1428077
Phone: 904.994.9626
Fax: 904.372.9011
Email: flintr@comcast.net
March 21, 2012
1335 Rose St.
Atlantic Beach, FL 32233
Proposal
We hereby propose to furnish all the materials and perform all the labor necessary for the completion of
1135 Rose St. Septic Abandonment/City Sewer Connection
Scope of Work:
• Pull permit and pass required inspections with the City of Atlantic Beach and the Health
Department.
• Labor, Materials and permits to abandon, pump, crush and fill the existing septic tank according to
Duval County Health Department guidelines and regulations.
• Install New 4" PVC gravity sewer from abandon tank approximately 135' to new city sewer tap
located in front yard. New sewer will have 2 clean-outs.
• Clean area of all related debris.
Exclusions, but not limited to:
• Yard will be neatly graded and fencing placed back. No sod or grass seed included.
• Not responsible for any future pine tree damage due to root removal in order to install new sewer.
• Any undisclosed conditions.
• Any scope of work not discussed in this proposal.
Total Bid: $3,850.00
This proposal was approved on this day of ,2012,by:
(Signature)
(Print Name)
Department of the Treasury— Internal Revenue Service 2� O
Form 1 040 U.S. Individual Income Tax Return (99) IRS Use Only—Do not write or staple in this space.
Name, For the year Jan 1 -Dec 31,2010,or other tax year beginning ,2010,ending ,20 OMB No.1545-0074
Your first name MI Last name Your social security number
Address,
and SSN FINIS R BENNETT, JR 261-15-1972
If a joint return,spouse's first name MI Last name Spouse's social security number
See separate
instructions. Home address(number and street).If you have a P.O.box,see instructions. Apartment no. Make sure the SSN(s)
1335 ROSE STREET .above and on line 6c
are correct.
City,town or post office.If you have a foreign address,see instructions. State ZIP code
Checkin
Presidential ATLANTIC BEACH ,,` FL 32233 change yourbtax orrfuox below lanot
Election
Campaign , Check here if you,or your spouse if filing jointly,want$3 to go to this fun . ..i'®; . 0 _You El Spouse
Filing Status 1 X Single 4 1,„ L • sehold (with qualifying person). (See
. - If the qualifying person is a child
2 _ Married filing jointly(even if only one had income) b t no yr •-ndent, enter this child's
Check only 3 _ Married filing separately.Enter spouse's SSN above&full name h-
one box. name here.. 5 n Qualify! • widow(er)with dependent child
Boxed
Exemptions 6a X Yourself. If someone can claimyou as a dependent,do not check box 6a on 6a and
6b .
P � on 6a and 6b .. 1
b _ Spouse No.of children
(2)Dependent's (3)Dependent's (4)/if on 6c who:
c Dependents: child under •lived
social securityrelationship
x�
number to you p qualifing for with you
child-tax cr • did not
(1) First name Last name (see instrs) live with you
[1 I
due to divorce
I or separation
If more than four n (See separation
...
dependents, see on&ops
instructions and I I entered above .
check here ... I►n ri Add numbers
on lines
d Total number of exemptions claimed above 1
7 Wages, salaries, tips, etc. Attach Form(s)W-2 7
Income 8a Taxable interest. Attach Schedule B if required 8a
b Tax-exempt interest. Do not include on line 8a L 8b1
Attach Form(s) 9a Ordinary dividends. Attach Schedule B if required 9a
W-2 here.Also b Qualified dividends 1 9bI
attach Forms
W-2G and 1099-R 10 Taxable refunds, credits, or offsets of state and local income taxes 10
if tax was withheld. 11 Alimony received 11
12 Business income or (loss). Attach Schedule C or C-EZ 12 13, 898.
If you did not
get a W-2, 13 Capital gain or(loss).Att Sch D if reqd.If not reqd,ck here 13
see instructions. 14 Other gains or (losses). Attach Form 4797 14
15a IRA distributions 15a bTaxable amount 15b
16a Pensions and annuities 16a bTaxable amount 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
Enclose,but do 18 Farm income or (loss). Attach Schedule F 18 _
not attach,any 19 Unemployment compensation 19
payment.Also,
20 a Social security benefits 120aI I b Taxable amount 20 b
please use
Form 1040-V. 21 Other income 21
22 Combine the amounts in the far right column for lines 7 through 21.This is your total income 0' 22 13, 898.
23 Educator expenses 23
Adjusted 24 Certain business expenses of reservists,performing artists,and fee-basis
Gross government officials.Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 25
26 Moving expenses. Attach Form 3903 26
27 One-half of self-employment tax. Attach Schedule SE 27 982 .
28 Self-employed SEP, SIMPLE, and qualified plans 28
29 Self-employed health insurance deduction 29
30 Penalty on early withdrawal of savings 30
31 a Alimony paid b Recipient's SSN .... 31 a
32 IRA deduction 32
33 Student loan interest deduction 33
34 Tuition and fees. Attach Form 8917 34
35 Domestic production activities deduction.Attach Form 8903 35
36 Add lines 23-31a and 32-35 36 982 .
37 Subtract line 36 from line 22. This is your adjusted gross income " 37 12, 916.
BAA For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see separate instructions. FDIA0112 12/22/10 Form 1040 (2010)
For-n-110400)10) FINIS R BENNETT, JR 261-15-1972 Page 2
Tax and 38 Amount from line 37(adjusted gross income) _ 38 12,916.
Credits 39a Check You were born before January 2, 1946, _ Blind. Total boxes
if: _ Spouse was born before January 2, 1946, _ Blind. checked 0' 39a
b If your spouse itemizes on a separate return,or you were a dual-status alien,check here 0" 39b 7,,
40 Itemized deductions(from Schedule A)or your standard deduction(see instructions) 40 5, 7 0 0.
41 Subtract line 40 from line 38 41 7, 216.
42 Exemptions.Multiply$3,650 by the number on line 6d 42 3, 6 5 0.
43 Taxable income.Subtract line 42 from line 41.
If line 42 is more than line 41,enter-0- _ 43 3, 5 6 6.
44 Tax(see instrs). Check if any tax is from: a Form(s)8814
b Form 4972 44 3 5 8.
45 Alternative minimum tax(see instructions). Attach Form 6251 45
46 Add lines 44 and 45 . 46 358.
47 Foreign tax credit.Attach Form 1116 if required 47
48 Credit for child and dependent care expenses.Attach Form 2441 48
49 Education credits from Form 8863, line 23 49
50 Retirement savings contributions credit.Attach Form 8880 50
51 Child tax credit(see instructions) 51
52 Residential energy credits. Attach Form 5695 52
53 Other crs from Form: a 0 3800 b 0 8801 c 0 53
54 Add lines 47 through 53. These are your total credits 54
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- ' 55 3 58.
Other 56 Self-employment tax.Attach Schedule SE 56 1, 9 64.
Taxes 57 Unreported social security and Medicare tax from Form: a ❑4137 b 0 8919 57
58 Additional tax on IRAs,other qualified retirement plans,etc.Attach Form 5329 ifr uired 58
59a ElForm(s)W-2, box 9 b 0 Schedule H c Form 5405, line 16 59
60 Add lines 55-59.This is your total tax 60 2, 322 .
Payments 61 Federal income tax withheld from Forms W-2 and 1099 61
62 2010 estimated tax payments and amount applied from 2009 return 62
If you have a L 63 Making work pay credit. Attach Schedule M 63 4 0 0.
qualifying 64a Earned income credit(EIC) 64a 41 .
child, attach rb Nontaxable combat pay election 01 64bj
Schedule EIC.
65 Additional child tax credit.Attach Form 8812 65
66 American opportunity credit from Form 8863, line 14 66
67 First-time homebuyer credit from Form 5405, line 10 67
68 Amount paid with request for extension to file 68
69 Excess social security and tier 1 RRTA tax withheld 69
70 Credit for federal tax on fuels.Attach Form 4136 70
71 Credits from Form: a 0 2439 b El 8839 c Il 8801 d 0 8885 71
72 Add Ins 61-63,64a,&65-71.These are your total pmts 72 4 41.
Refund 73 If line 72 is more than line 60,subtract line 60 from line 72.This is the amount you overpaid _ 73
74a Amount of line 73 you want refunded to you.If Form 8888 is attached, check here .. _ 74a
► b Routing number XXXXXXXXX ► c Type: n I Checking 0 Savings
Direct deposit? It. d Account number
See instructions.
75 Amount of line 73 you want applied to your 2011 estimated tax 175
Amount 76 Amount you owe.Subtract line 72 from line 60.For details on how to pay see instructions 76 1, 921 .
You Owe 77 Estimated tax penalty (see instructions) 177 I 4 0.
Do you want to allow another person to discuss this return with the IRS(see instructions)? Yes.Complete below. 0 No
Third Party —
Designee Designee's Phone Personal identification
name ► no. ► number(PIN) ►
Sign Under penalties of perjury,I declare that I have examined this return and accompanying schedules and statements,and to the best of my knowledge and
belief,they are true,correct,and complete.Declaration of preparer(other than taxpayer)is based on all information of which preparer has any knowledge.
Here Your sig ature Date Your occupation Daytime phone number
Joint return?
See instructions. ,r„ / 3.#' ' '- 7� • SELF–EMPLOYED
Keep a copy Spouse's signature.If a joint return,both must si9rr Date Spouse's occupation
for your records. ' , f1'- --/-5",
'^/"(.5",
Printfrype preparer's name Preparer's signature Date Check Lr if PTIN
Paid JAMES K. REESE, EA JAMES K. REESE, EA self-employed P00809299
Preparer's Firm's name ►TAX ADVANTAGE, INC.
Use Only Firm's address► 1201 NORTH THIRD STREET Firm's EIN ► 59-3513153
JACKSONVILLE BEACH FL 32250-7242 Phone no. (904) 241-0050
Form 1040(2010)
FDIA0112 12/22/10
SCHEDULE C Profit or Loss From Business OMBNo.1545-0074
(Form 1040) (Sole Proprietorship) 201 0
Department of the Treasury Partnerships,joint ventures,etc,generally must file Form 1065 or 1065-B. Attachment
Internal Revenue Service (99) 'Attach to Form 1040,1040NR,or 1041. ►See Instructions for Schedule C(Form 1040). Sequence No. U9
Name of proprietor Social security number(SSN)
FINIS R BENNETT, JR 261-15-1972
A Principal business or profession,including product or service(see instructions) B Enter code from instructions
TREE REMOVAL/TRIMMING/LANDSCAPE SERVICES 1' 812990
C Business name.If no separate business name,leave blank. D Employer ID number(EIN),if any
JR'S SERVICES
E Business address(including suite or room no.)'13 3 5 ROSE STREET
City,town or post office,state,and ZIP code ATLANTIC BEACH, FL 3 2 2 3 3
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) ► ______
G Did you 'materially participate' in the operation of this business during 2010? If'No,' see instructions for limit on losses.... ILI Yes No
H If you started or acquired this business during 2010, check here
Part,I Income
1 Gross receipts or sales. Caution.See instructions and check the box if:
• This income was reported to you on Form W-2 and the 'Statutory employee' box on that form was
checked, or
• You are a member of a qualified joint venture reporting only rental real estate income not subject
to self-employment tax. Also see instructions for limit on losses � 1 21, 442 .
2 Returns and allowances 2
3 Subtract line 2 from line 1 3 21, 442.
4 Cost of goods sold (from line 42 on page 2) 4
5 Gross profit.Subtract line 4 from line 3 5 21, 442.
6 Other income, including federal and state gasoline or fuel tax credit or refund
(see instructions) 6
7 Gross income.Add lines 5 and 6 ► 7 21,442 .
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising 8 18 Office expense 18
9 Car and truck expenses 19 Pension and profit-sharing plans 19
(see instructions) 9 5,473 . 20 Rent or lease (see instructions):
10 Commissions and fees 10 a Vehicles, machinery, and equipment 20a
11 Contract labor b Other business property 20 b
(see instructions) 11 21 Repairs and maintenance 21
12 Depletion 12 22 Supplies (not included in Part III) 22 1, 087.
13 Depreciation and section 23 Taxes and licenses 23
179 expense deduction 24 Travel, meals, and entertainment:
(not included In Part III)
(see instructions) 13 a Travel 24a
14 Employee benefit programs b Deductible meals and entertainment
(other than on line 19) 14 (see instructions) 24b
15 Insurance (other than health) ... 15 25 Utilities 25
16 Interest: 26 Wages (less employment credits) 26
a Mortgage(paid to banks,etc) 16a 27 Other expenses(from line 48 on
b Other 16 b page 2) 27 9 8 4.
17 Legal & professional services 17
28 Total expenses before expenses for business use of home. Add lines 8 through 27 28 7, 544.
29 Tentative profit or (loss). Subtract line 28 from line 7 29 13, 898.
30 Expenses for business use of your home. Attach Form 8829 30
31 Net profit or(loss).Subtract line 30 from line 29.
• If a profit, enter on both Form 1040,line 12,and Schedule SE,line 2 or on Form
1040NR,line 13(if you checked the box on line 1, see instructions). Estates and
trusts, enter on Form 1041,line 3. — 31 13, 898.
• If a loss, you must go to line 32. _
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Form 1040,line 12,and Schedule SE,line 2,or on Form
1040NR,line 13(if you checked the box on line 1, see the line 31 instructions). Estates and trusts, enter — All investment is
on Form 1041,line 3. 32 a ❑ at risk.
nSome investment
• If you checked 32b, you must attach Form 6198.Your loss may be limited. 32 b I I is not at risk.
BAA For Paperwork Reduction Act Notice,see your tax return instructions. Schedule C (Form 1040) 2010
FDIZ0112 12/27/10
Schedule•C (Form 1040)2010 FINIS R BENNETT, JR 261-15-1972 Page 2
Part III Cost of Goods Sold (see instructions)
38 Method(s) used to value closing inventory: a Cost b ❑ Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If'Yes,' attach explanation Yes El No
35 Inventory at beginning of year. If different from last year's closing inventory,
attach explanation 35
36 Purchases less cost of items withdrawn for personal use 36
37 Cost of labor. Do not include any amounts paid to yourself 37
38 Materials and supplies 38
39 Other costs 39
40 Add lines 35 through 39 40
41 Inventory at end of year 41
42 Cost of goods sold.Subtract line 41 from line 40. Enter the result here and on page 1, line 4 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not
required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562.
43 When did you place your vehicle in service for business purposes? (month, day, year) P. 01/01/2 0 0 0
44 Of the total number of miles you drove your vehicle during 2010, enter the number of miles you used your vehicle for:
a Business 10, 946 b Commuting (see instructions) cOther 4, 716
45 Was your vehicle available for personal use during off-duty hours? X❑Yes ❑No
46 Do you (or your spouse) have another vehicle available for personal use? X❑Yes _No
47a Do you have evidence to support your deduction? X❑Yes No
b If 'Yes,' is the evidence written? VI Yes ri No
Part V Other Expenses. List below business expenses not included on lines 8-26 or line 30.
COMMUNICATIONS 984.
48 Total other expenses.Enter here and on page 1, line 27 48 984.
Schedule C (Form 1040) 2010
FDIZ0112 12/27/10
SCHEDULE SE OMB No.1545-0074
(Fo•rm 1040) Self-Employment Tax 2010
Department of the Treasury Attachment
Internal Revenue Service (99) ► Attach to Form 1040 or Form 1040NR. P. See Instructions for Schedule SE(Form 1040). sequence No. 17
Name of person with self-employment income(as shown on Form 1040)
Social security number of person
FINIS R BENNETT, JR with self-employment income ► 261-15-1972
Before you begin:To determine if you must file Schedule SE, see the instructions.
May I Use Short Schedule SE or Must I Use Long Schedule SE?
Note.Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE, in the instructions.
Did you receive wages or tips in 2010?
No Yes
V V V
Are you a minister, member of a religious order, or Yes Yes
Christian Science practitioner who received IRS approval Was the total of your wages and tips subject to social
not to be taxed on earnings from these sources,but you security or railroad retirement (tier 1) tax plus your net
owe self-employment tax on other earnings? earnings from self-employment more than $106,800?
No No
V
Are you using one of the optional methods to figure your Yes Did you receive tips subject to social security or Medicare Yes
net earnings (see instructions)? tax that you did not report to your employer? --►
No No
T
Did you receive church employee income (see instruc- Yes No Did you report any wages on Form 8919, Uncollected Yes
tions) reported on Form W-2 of$108.28 or more? f—Social Security and Medicare Tax on Wages?
No
V V
You may use Short Schedule SE below ►I You must use Long Schedule SE on page 2
Section A — Short Schedule SE. Caution.Read above to see if you can use Short Schedule SE.
1 a Net farm profit or(loss)from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A 1 a
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 6b, or listed on Schedule K-1 (Form 1065), box 20,
code Y 1 b
2 Net profit or (loss)from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14,
code A(other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1. Ministers and members
of religious orders, see instrs for types of income to report on this line. See instrs for other income
to report 2 13, 8 9 8.
3 Combine lines la, 1b, and 2. Subtract from that total the amount on Form 1040, line 29, or Form 1040NR,
line 29, and enter the result (see instructions) 3 13, 898.
4 Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax;do not file this
schedule unless you have an amount on line lb 4 12, 83 5.
Note.If line 4 is less than $400 due to Conservation Reserve Program payments on line 1 b, see instructions.
5 Self-employment tax. If the amount on line 4 is:
•$106,800 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040,line 56,
or Form 1040NR,line 54.
•More than $106,800, multiply line 4 by 2.9% (.029). Then, add $13,243.20 to the result. Enter the 5 1, 964.
total here and on Form 1040,line 56,or Form 1040NR,line 54.
6 Deduction for one-half of self-employment tax.Multiply line 5 by 50% (.50).
Enter the result here and on Form 1040,line 27 or Form 1040NR,line 27 6 982 .
BAA For Paperwork Reduction Act Notice,see your tax return instructions. Schedule SE (Form 1040) 2010
FDIA1101 12/29/10
SCHEDULE M OMB No.1545-0074
(Form 1040A or 1040) Making Work Pay Credit 2010
Department of the Treasury ► Attach to Form 1040A or 1040. ► See separate instructions. Attachment 66
Internal Revenue Service (99) Sequence No.
Name(s)shown on return Your social security number
FINIS R BENNETT, JR 261-15-1972
Caution: To take the making work pay credit,you must include your social security number(if filing a joint return, the number of either you or
your spouse)on your tax return. A social security number does not include an identification number issued by the IRS. Only the
Social Security Administration issues social security numbers.
Caution: You cannot take the making work pay credit if you can be claimed as someone else's dependent or if you are a nonresident alien.
Important:Check the'No' box on line 1a and see the instructions if:
(a) You have a net loss from a business,
(b) You received a taxable scholarship or fellowship grant not reported on a Form W-2,
(c) Your wages include pay for work performed while an inmate in a penal institution,
(d) You received a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental
section 457 plan, or
(e) You are filing Form 2555 or 2555-EZ.
1 a Do you(and your spouse if filing jointly)have 2010 wages of more than$6,451 ($12,903 if married filing jointly)?
Yes.Skip lines 1 a through 3. Enter $400($800 if married filing jointly) on line 4 and go to line 5.
XX No.Enter your earned income (see instructions) 1 a 12, 916.
b Nontaxable combat pay included on line 1 a
(see instructions) I 1 bI
2 Multiply line la by 6.2% (.062) 2 801.
3 Enter $400 ($800 if married filing jointly) 3 400.
4 Enter the smaller of line 2 or line 3 (unless you checked 'Yes' on line la) 4 400.
5 Enter the amount from Form 1040, line 38*, or Form 1040A, line 22 5 12, 916.
6 Enter$75,000 ($150,000 if married filing jointly) 6 75, 000.
7 Is the amount on line 5 more than the amount on line 6?
X No.Skip line 8. Enter the amount from line 4 on line 9 below.
Yes.Subtract line 6 from line 5 7
8 Multiply line 7 by 2% (.02) 8
9 Subtract line 8 from line 4. If zero or less, enter -0- 9 400.
10 Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2010? You may have
received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received
social security benefits, supplemental security income, railroad retirement benefits, or veterans disability
compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions).
X❑ No.Enter -0- on line 10 and go to line 11.
❑ Yes.Enter the total of the payments you (and your spouse, if filing jointly) received in 2010.
Do not enter more than $250 ($500 if married filing jointly) 10 0.
11 Making work pay credit.Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on
Form 1040, line 63; or Form 1040A, line 40 11 400.
*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions
BAA For Paperwork Reduction Act Notice,see your tax return instructions. Schedule M (Form 1040A or 1040) 2010
FDIA8501 09/20/10
ENVIRONMENTAL REVIEW SCREENING CHECKLIST
CITY OF JACKSONVILLE CDBG, HOME, HOPWA, ESG
HOUSING CONSTRUCTION
PROPERTY ADDRESS
COUNTY Duval STATE Florida ZIP 32233
PROJECT NAME(S) Rueben Bennett Jr. 1335 Rose St.Atlantic Beach FL
1. HISTORIC PROPERTIES
a. Is the structure in a Historic District of over 50 years old? Yes_No X
b. If yes, indicate consultation and completion of Section 106 process
2. FLOOD PLAIN MANAGEMENT
a. Is structure in 100 year Floodplain Yes No X
b. FEMA panel Number 120075 0001 D
c. Date of Map Current data was also utilized and attached.
d. If yes above, has flood insurance been required? Yes No X
e. Is Flood Certification Documentation attached? Yes X No
3. WETLANDS PROTECTION
a. Is the structure in a wetland Yes_No X
b. If yes,indicate compliance with EO 11990(an 8 step process) Yes_No X
c. If yes, has the Corps of Engineers been consulted? Yes_No X
d. If consulted, has the Corps of Engineers been satisfied? Yes No X
4. NOISE
a. Is the structure within 3000 feet of a railway, 1000 feet of a major thoroughfare,or within 5 miles
of an airport? Yes No X
b. If yes,indicate maps consulted(Hartsfield International Airport)or mitigation measures to reduce
noise:
5. RUNWAY CLEAR ZONES,CLEAR ZONES AND ACCIDENT POTENTIAL ZONE(APZ)
a. Is the structure located within runaway clear zones or clear zones and APZ of Jacksonville
international Airport? Yes No X
b. If yes, please describe:
6. THERMAL AND EXPLOSIVE HAZARDS
a. Based on maps,studies and on-site visits,are there storage tanks and other facilities(within one mile)
that pose danger to the property? Yes_No X
b. If yes, explain, including any mitigation measures needed:
7. TOXIC AND HAZARDOUS CHEMICALS
a. Is project on or within one mile of area,which contains or may contain hazard waste?
Yes No X
8. ENVIRONMENTAL JUSTICE
a. Will impact be positive to low/moderate income families? Yes X No_
I hereby certify that the information is true and complete. What is now being proposed is covered within the
scope of FY 2011-2016 Consolidated Plan and the Format II Environmental Assessment for FY 2011-2016
Funding. Ple se eat c d docume tion.
Signed: r
Michael Griffin, , FM Building and Zoning Director Date:July 16, 2012
Page 1 of 1
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http://maps.coj.net/output/DuvalMapsSQL_itdgism640644536117386.png 7/16/2012
1. Customer contacts City about sewer &/or water conversion
/2. Customer referred to Utility Director in Public Utilities
v‘‘ CAB Public Utilities Form is completed by Utility Director
4 Customer is contacted by ??? in Utilites regarding costs involved in conversion
✓5. CAB Public Utilities Form is forwarded to Accountant & BCE?
If home is owner occupied, Public Utilities Form is forwarded to Assistant City Manager; if home is
/not owner occupied, the Public Utilities Form is forwarded to the Accountant
`7. If home is owner occupied & owner does not qualify for CDBG, contact info forwarded to Accounta
/by the Assistamt City Manager
V . Accountant will discuss payment options with home owner(if not owner occupied & owner does no
/reside in CAB, only financing available is 5%)
9. If home owner finances conversion with the City Accountant will: prepare financing documents,
forward them to Finance Director & Utility Director for review & approval, approved documents wi
be forwarded to the City Clerk
10. City Clerk will contact home owner, execute the documents & retain the originals
11. Copy of executed agreements will be forwarded by the City Clerk to the Accountant
12. The Accountant will forward copies of the signed documents, contractor's estimate & amortization
schedule to the: Building Permits Coordinator, Utility Billing Supervisor, Utility Director, Purchasir.
Agent & Contractor (if requested)
13. Utility Director will enter requisition for contractor &/or check request for any City related fees
14. PO will be sent to Contractor&Utility Director by the Purchasing Agent
15. Conversion can begin
16.
When conversion is complete & home owner is satisfied with the job, the Utility Director will notify
the Purchasing Agent the PO can be paid & the City Clerk that the lien on the property can be filed
17. Copies of the documents with the Clerk of Courts info will be forwarded to the Accountant by the
City Clerk
18. Charges are entered in SunGard CX application by the Utility Billing Supervisor or AR application
the Accountant
H:\SepticTank\[2011 Septic Tank Procedures.xls]Procedures
► [ fl Cyd
INCOME VERIFICATION FO ' i� MAY 2 3 n»
By •
PART I. (To be filled out by the person (employee) completing this applica `,
(Applicant,)Employee name:
Address: / -7 3 C C 3- ° n7z/. �.�0¢'
Social Security Number: 2&. / / S ^ � 9 7
I hereby authorize release of my income information to the City of Atlantic Beach for
the purpose of applying for participation in the septic to sewer conversion funding
assistance Program, which is funded by a Community Development Block Grant.
,SW 3 /
Signature of Owner Date /
PART II. (To be filled out by employer, Social Security Administration or HRS.)
Please provide the following information and return to:
Community Development Department
City of Atlantic Beach
800 Seminole Road
Atlantic Beach, Florida 32233
Applicant / Employees Name:
Gross Monthly Income: $ rryso-� 44,P"o
Is employment: permanent part-time temporary
ilk
Employer Name: 4
Address: Telephone: o?9s7-S3
Name and title of person providing this information. Date
Page 3 of 3
10. Does your plumbing work properly? 71 Yes ❑No
If no,please explain.
11. Is there hot and cold running water in your house? Yes ❑ No
12. Do you have a complete kitchen with running water,a refrigerator and cooking facilities?
13. How many persons are in your family and living at this address? 2--
14. Federal regulations require that we keep track of certain demographic information and the type of
households being served. Please check the appropriate box below.
rWhite,Not Hispanic
❑ African-American,Not Hispanic
❑ American Indian or Native Alaskan
❑ Hispanic
❑ Asian or Pacific Islander
❑ Female Head of Household
❑ Other _ Jet, '`T
15. What is the total annual income(before taxes) of your household? / /6
16. Are you on a fixed income such as Social Se rity, SI or retirement? [1]Yes No
17. What are your sources of income? triC" in
18. Do you own this home? in Yes ❑ No
If you own your home, please provide a copy of your deed and a recent water or electric bill which shows that
you live at t address. If. •u re •. r ome, lease provide a copy of the lease
/°°
%.0 5 ,P1''-- / L____
ignature of Owner Date
If you have any questions about this application or need any assistance preparing
the application, please contact the City of Atlantic Beach at (904) 247-5817.
The following Income Verification Form must also be completed and mailed or
delivered to:
Community Development Department
City of Atlantic Beach
800 Seminole Road
Atlantic Beach, Florida 32233
Please provide the time of day and day of the week (Monday through Friday) when it would be
most convenient to make arrangeme 1 is for a ; , nsp:ctor t : - with you, and the phone
number where you wish to be called.
,—
Page 2 of 3
Griffin, Michael
From: Griffin, Michael
Sent: Tuesday, May 22, 2012 10:42 AM
To: Bartle, Donna
Subject: CDBG agreement for F. Rueben Bennett
Attachments: Bennettagreement.docx; Bennettapplication.pdf; Bennetttaprequest.pdf
Donna,
Please review the attached documents and request Mr. Bennett's signature.Also please have Jim sign the agreement,
and forward to Debbie Ramsey for processing. Mr. Bennett can be reached at 294-5158.
Thanks
Michael Griffin, CBO, CFM
Building Official/Interim Community Development Director
800 Seminole Road
City of Atlantic Beach,Florida 32233-5445
mariffin@coab.us
Telephone 904-247-5813 Fax 904-247-5845
http://www.coab.us/
1
Property Appraiser - Property Details Page 1 of 2
BENNETT F RUEBEN JR Primary Site Address Official Record Book/Page Tile#
1335 ROSE ST 1335 ROSE ST 15071-00383 9417
ATLANTIC BCH, FL 32233 Atlantic Beach FL 32233
1335 ROSE ST
Property Detail Value Summary
RE# 171064-0120 2011 CertMed 2012 In Progress
Tax District USD3 Value Method CAMA CAMA
Perry Use 0100 SINGLE FAMILY Total Building Value $6,042.00 $33,537.00
#of Buildings 1 Extra Feature Value $116.00 $117.00
18-34 17-2S-29E Land Value(Market) $35,798.00 $20,960.00
Legal Desc. SEC H ATLANTIC BEACH Land Value(Agric.) $0.00 $0.00
Subdivision 03119 ATLANTIC BEACH SEC H Just(Market)Value $81,956.00 $54,614.00
The sale of this property may result in higher property taxes.For more information go Assessed Value $81,956.00 $54,614.00
to Save Our Homes and our Property Tax Estimator.Property values,exemptions and Cap Diff/Portability Amt $0.00/$0.00 $0.00/$0.00
other information listed as'In Progress'are subject to change.These numbers are
part of the 2012 working tax roll and will not be certified until October.Learn how the Exemptions $50,000.00 See below
Property Appraiser's Office values property. Taxable Value $31,956.00 See below
Taxable Values and Exemptions—In Progress
If there are no exemptions applicable to a taxing authority,the Taxable Value is the same as the Assessed Value listed above in the Value Summary box.
County/Municipal Taxable Value SJRWMD/FIND Taxable Value School Taxable Value
Assessed Value $54,614.00 Assessed Value $54,614.00 Assessed Value $54,614.00
Homestead Exemption(HX) -$25,000.00 Homestead Exemption(HX) -$25,000.00 Homestead Exemption(HX) -$25,000.00
Amend 1 Homestead(HB) -$4,614.00 Amend 1 Homestead(HB) -$4,614.00 Taxable Value $29,614.00
Taxable Value $25,000.00 Taxable Value $25,000.00
Sales History
Book/Page Sale Date Sale Price Deed Instrument Type Code I Qualified/Unqualified Vacant/Improved
15071-00383 11/17/2009 $14,500.00 I WD-Warranty Deed I Unqualified Improved
13526-01951 9/8/2006 $100.00 I QC-Quit Claim Unqualified Improved
06901-02335 5/9/1990 $29,600.00 QC-Quit Claim I Unqualified I Improved
05929-01035 2/6/1985 $8,000.00 I WD-Warranty Deed I Unqualified I Improved
Extra Features
LN I Feature Code Feature Description I Bldg. I Length I Width I Total Units I Value
1 1 PVCR1 Paving Concrete 1 10 0 1112.00 $117.00
Land&Legal
Land Legal
I LN Code I Use Description I Zoning Front I Depth Category Land Units Land Value LN I Legal Description
1 0101 RES MD 8-19 UNITS PER AC I ARG-1A 37.00 1150.00 I Common 37.00 $20,960.00 1 18-34 17-2S-29E
2 SEC H ATLANTIC BEACH
3 S 12.5FT LOT 4,N 25FT LOT 5
4 BLK 235
Buildings
Building 1
Building 1 Site Address Element 1 Code I Detail
2
ta5 ROSE ST
sr i
Atlantic Beach FL 32233 Exterior Wall 16 16 Tile/Frame Stucco _u._L._
Roofing Structure 3 3 Gable or Hip
Building Type 0105-TOWNHOUSE SOH Roofing Cover 3 3 Asph/Comp Shingle T
Year Built 1985 Interior Wall 5 5 Drywall
RAs
Int Flooring 11 11Ceramic Clay Tile
Type I Gross Area I Heated Area Heating Fuel 4 4 Electric
Base Area 940 940 Heating Type 4 4 Forced-Ducted
Unfinished Storage 64 0 Air Conditioning 1 3 13 Central
¢)
Unfin Open Porch 52 0
Total 1056 940 Element I Code I
Stories 1.000 I
http://apps.coj.net/pao_propertySearchBasic/Detail.aspx?RE=1710640120 5/22/2012
Property Appraiser - Property Details Page 2 of 2
Bedrooms 2.000
Baths I 1.000 I
Rooms/Units 1.000 j
2011 Notice of Proposed Property Taxes(Truth in Millage Notice)
Taxing District i Assessed Value Exemptions Taxable Value I Last Year I Proposed I Rolled-back
Gen Govt Beaches 1$81,956.00 $50,000.00 $31,956.00 $258.61 I$215.53 $230.32
Public Schools:By State Law $81,956.00 $25,000.00 $56,956.00 $338.64 $302.15 $325.59
By Local Board $81,956.00 $25,000.00 $56,956.00 $158.23 $128.04 $152.14
FL Inland Navigation Dist. $81,956.00 $50,000.00 $31,956.00 $1.32 $1.10 $1.14
Atlantic Beach $81,956.00 $50,000.00 $31,956.00 $120.99 $106.37 $106.37
Water Mgmt Dist.SJRWMD $81,956.00 $50,000.00 $31,956.00 $15.94 $10.59 $14.41
Gen Gov Voted $81,956.00 $50,000.00 $31,956.00 $0.00 $0.00 $0.00
School Board Voted I$81,956.00 $25,000.00 $56,956.00 $0.00 $0.00 $0.00
Urban Service Dist3 I$81,956.00 $50,000.00 I$31,956.00 $0.00 $0.00 $0.00
I I Totals $893.73 $763.78 $829.97
3ust Value Assessed Value Exemptions Taxable Value
Last Year $88,344.00 $88,344.00 $50,000.00 $38,344.00
Current Year J$81,956.00 $81,956.00 $50,000.00 $31,956.00
Property Record Card(PRC)
The Property Appraiser's Office(PAO)provides historical property record cards(PRCs)online for 1995-2005.The PAO no longer maintains a certified PRC file due
to changes in appraisal software;therefore,there are no PRCs available online from 2006 forward.You may print this page which provides the current property
record.(Sections not needed can be minimized.)To print the past-year cards below,set your browser's Page Set Up for printing to Landscape.
2005 12004 1 201 12002 12001 12000 11999 11998 11997 11996 11995
More Information
Parcel Tax Record I GIS Mao I Mao this property on Google Maps I aty Fees Record
http://apps.coj.net/pao propertySearch/Basic/Detail.aspx?RE=1710640120 5/22/2012
1. Meet with applicant and provide application form and verify:
A.verification of income
B. sewer service availability
C. owner occupied status
2. Provide list of plumbing contractors that can provide quotes
3. Owner to obtain quotes
4. Donna Kaluzniak to provide costs of installation on Sewer Tap Fee form
5.Agreement is drafted for property owner and Jim Hanson to sign.
6. Work is completed and a paid by City. Money is recouped by grant or financing.
11121 JOHN H. MOON PLUMBING CO.
Remodels • New Construction • Evening and Weekend Hours
State Certified CFC 019200
- ESTABLISHED IN 1981 11. 7 ----J
A - Phone (904) 249-2758 24,
r
Customer's
Order No. _ 5i9<614/ Phone 7 Date 37--77/2
Name / �-- -.-4,--„
Address 1 4,
1.-Ci ��
ESTIMATE PAID DEPOSIT PD PAYMENT FINAL PMT BAL DUE
U CASH
U CHECK#
QUAN. DESCRIPTION PRICE AMOUNT
edi/tA /74
4.2-r' e 1 let:trol- -/If& e4/ ----
7-e- 5 "..707:4_,
ce.„-gt_gc,L.,„‘ir,ae ,c1,:c.iAde
7r1 or' .17/b-&-.6 a 3,23 -2/
( /f1/ D gt1---e0 cL-n-r 1.t_4. 4d1
MAR 0 5 ?012
I
By- —
All claims and returned good MUST be accompanie by this bill. TAX
Received
By �� TOTAL G3 ,,e,
ALL ACCOUNTS OVER 30 DAYS WILL BE CHARGED 1 1/2%INTEREST.ALL ACCOUNTS OVER 90 DAYS
WILL BE C.O.D.ALL ACCOUNTS OVER 120 DAYS WILL BE TURNED OVER TO A COLLECTION AGENCY
FOR COLLECTION.REASONABLE ATTORNEYS FEES FOR COLLECTION WILL BE ADDED.
f--
r CITY OF ATLANTIC BEACH
J ) PUBLIC UTILITIES
/ 1200 Sandpiper Lane
/ ATLANTIC BEACH,FL 32233
J s,>>- (904)270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 5/21/12 Project Address: 1335 Rose St.
No. of Units: 1 Commercial Residential X Multi-Family
New Water Tap(s)&Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer 1
Name: Reuben Bennett
Applicant Address:
City: State: Zip:
Phone Number: 568-6067 Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
SDC Fees Pd.
Water System Development Charge $
Sewer System Development Charge $ N/A
Water Meter Only $
Water Meter Tap $
Sewer Tap $ N/A
Cross Connection $
Other (Plumber) $ 2,350.00
TOTAL $ 2,350.00
(notes)
APPROVED: Donna Kaluzniak 5/21/12
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
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7643
Pars Gate (904) Resident
00004483 Construction Parkway Jacksonville FL 32256 Ali Hakimi 642- ahakimi@pars-construction.com 8/10/2013 prime
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104-82
Pinnacle Civil 14286-19
and Gen Beach Javier (904) Resident
°0003660 Contractors Su le # JacksonvilleFL32250�mia 49275 jgarcia@pinnaclecgc.com 7/14/2012 primo
LLC 167
1225
Quantum West Patrick (561) Resident
00005607 Mechanical, Beaver Jacksonville FL 32204 Gordon 436- pat rck@quantummechanical.com2/17/2013 Employer
LLC. Street 0906
Suite 201
7855
Rivers Argyle Jennifer (904) Resident
00000983 Constructors,Forest Jacksonville FL 32244779- ginger@riversconstruction.com 2/24/2013
Inc. Boulevard Rivers 2300 Prime
Suite 703
Williams & 5975 Angie (904)
0000789Q Williams GCs and Wakulla Jacksonville FL 32258 Williams- 335- WilllamsAndW@aol.com 7/16/2012 Resident
Engineering Spring Rd Hollowell 2122 Prime
Xeye 3035 Joseph (904) Resident
00000889PowersPowers Jacksonville FL 32207 714- sales@xeyecorp.com 4/14/2013
Hutchinson primo
Ave. #4 2100
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Vendor Vendor Name Address City State Zip Contact Phone Email Address Expiration Sec 3 JSEB
ID Name Date Type Supplier
A to Z 406 Hamlet (904
0000175QContracting' Road FKA: Jacksonville FL 32221 Amy 390-) atortheleakmaster@comcast.net 1/30/2015 Resident
Inc. Leak Thomas 0907 Prime
Master
401 Agmac 32254-Mike (904) Resident
00000796 AC General,Inc. Avenue Jacksonville FL 2864 Johnston 783- mjohnston@acgeneral.net 11/18/2013 P„
4200 me
PO Box 651 (407)
00011295 Construction
419E Oakland FL 34760 Steve 877- stave@brittconstructioninc.com 5/4/2014 Resident
Construction Inc Oakland Brown 0000 Prime
Ave
Copeland 12341 (904)
00004782Professional Muscovy Jacksonville FL 32223 Raymond 589 cperayr@gmall.com 9/30/2014 Resident
Consultants Dr Rountree 0610 Owner
1029 (904)
00007480 Custom Homes bertha Jacksonville FL 32218 Larry 334- customhomesbylminc@comcast.net 2/24/2012 Resident
by L&M,Inc. street Leonard 4888 Prime
E.B. Morris 7011 (904)
00007425 General Business Jacksonville FL 32256 Eric 998- ebm@ebmorris.cc 1/21/2014 Resident
Contractors, Park Blvd. Moms 9281 Prime
Inc. North
flint 1419 Russell (904) Resident
0000444tconstructlon unkside Dr.Atlantic Beach FL 32233 Flint 994- flintr@comcast.net 3/17/2013 Employer
services, Inc. 9626
40 West
00006054 Four Star 16th Jacksonville FL 32206 Robert 355-) r4star4@bellsouth.net 8/10/2013 Resident
Plumbing, Inc Street Flomoy 1046 Prime
Same
Nolan Plumbing 12542 wayne (907) Resident
00003066 and Irrigation, woodcutterJacksonville FL 32220 783- JWN2009@COMCAST.NET 2/17/2013
nolan Employer
Inc. road 4321
4541 ST.
ONYX AUGUSTINE YVONNE (904) Resident
00007412 CONSTRUCTION,ROAD, ste. JACKSONVILLE FL 32207 THOMAS 342- ythomas@onyxconstn.Jctionlnc.com 8/29/2014 Employer
INC 6 6699
12