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Name and Address Type of Amount of <br />of Parties Involved Date Transaction Transaction <br />This affidavit is given in Compliance with the provisions of Section 286.23, Florida <br />Statutes. <br />AND FURTHER AFFIANT SAYETH NOT. <br />119001►il1 <br />SWORN TO AND SUBSCRIBED before me this day of � _ , 1999, by <br />, who is personally known to me or who has <br />produced <br />printed name, commission N <br />and date commission expires: <br />as identification. <br />4 <br />Notary Public <br />