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• <br /> i <br /> a 403 FOR PROFIT CORPORATION <br /> ',jNIFORM BUSINESS REPORT [ LIBR ) <br /> OOCUMENT # 126920 <br /> 1 . Entity Name ' <br /> GRAVES BROTHERS COMPANY 4_ <br /> Principal Place of Business Mailing Address <br /> 8465 OLD DIXIE HWY PO BOX 277 <br /> WABASSO FL 32970 WABASSO FL 32970 <br /> US US I IIIIII VIII VIII VIII VIII VIII IIII VIII VIII IIID ( IIII VIII ( IIII (III <br /> 2. Principal Place of Business 3. Mailing Address <br /> Suite , Apt . # , etc . Suite , Apt . # , etc . <br /> ❑ CHECK HERE IF MAKING CHANGES <br /> City & State City & State 4. FEI Number 59-0269180 Applied For . <br /> Not Applicable <br /> Zip Country Zip Country $8 , 75 Additional <br /> 5 . Certificate of Status Desired E] Fee Required <br /> 6. Name and Address of Current Registered Agent 7. Name and Address of New Registered Agent <br /> Name <br /> GRAVES, J.R., JR <br /> Street Address ( P. O . Box Number is Not Acceptable) <br /> 8465 OLD DIXIE HWY <br /> WABASSO FL 32970 <br /> City CI Zip Code <br /> 8. The above named entity submits this statement for the purpose of changing its registered office or registered agent , or both , in the <br /> State of Florida . Iram`familiar with , and accept <br /> the obligations of registered agent <br /> SIGNATURE <br /> Signature, typed or printed name of registered agent and title it applicable (IJOTE . Registered Agent signature required when reinstating ) <br /> DATE <br /> (wt <br /> 3WTf5� 1tLaQ # . <br /> 9 . Election Campaign Financing $ 5 . 00 May Be <br /> AtteiMayD�l3z�eeyanfili fse �55tl 0� Trust Fund Contribution ❑ Added to Fees <br /> Make Cfieefc payab #zs1�rfi�rDepi #rrierzi,of �5tate- <br /> 10. OFFICERS AND DIRECTORS 11 . ADDITIONS / CHANGES TO OFFICERS AND DIRECTORS IN 11 <br /> TITLE STD ❑ Delete TITLE ❑ Change ❑ Addition <br /> NAME BASS, ELIZABETH G NAME <br /> STREET ADDRESS 6275 N MIRROR LAKE DR STREET ADDRESS <br /> CITY - ST - ZIP SEBASTIAN FL CITY - ST - ZIP <br /> TITLE CD ❑ Delete TITLE ❑ Change ❑ Addition <br /> NAME GRAVES, RICHARD J JR NAME <br /> STREET ADDRESS 8465 OLD DIXIE HWY STREET ADDRESS <br /> CITY - ST- ZIP WABASSO FL 32970 CITY - ST - ZIP <br /> TITLE PD ❑ Delete TITLE _ ❑ Change ❑ Addition <br /> NAME BASS, JEFF E NAME <br /> STREET ADDRESS 8465 OLD DIXIE HWY STREET ADDRESS <br /> CITY - ST- ZIP WABASSO FL 32970 CITY - ST - ZIP <br /> TITLE V ❑ Delete TITLE ❑ Change ❑ Addition <br /> NAME HUFF, JAMES E NAME <br /> STREET ADDRESS 1545 SMUGGLERS COVE STREET ADDRESS <br /> CITY - ST- ZIP VERO BEACH FL CITY - ST - ZIP <br /> TITLE ❑ Delete TITLE ❑ Change ❑ Addition <br /> NAME NAME <br /> STREET ADDRESS STREET ADDRESS <br /> CITY - ST- ZIP CITY - ST - ZIP <br /> TITLE ❑ Delete TITLE ❑ Change ❑ Addition <br /> NAME NAME <br /> STREET ADDRESS STREET ADDRESS <br /> CITY - ST - ZIP CITY - ST - ZIP <br /> 12. 1 hereby certify that the information supplied with this filing does not qualify for the exemption stated in Section 119 . 07( 3 )( i ) , <br /> Florida Statutes . I further certify that the information <br /> indicated on this report or supplemental report is true and accurate and that my signature shall have the same legal effect as if made under <br />oath , that I am an officer or director <br /> of the corporation or the receiver ustee dowered to xecute this re ort as required by Chapter 607 , Florida Statutes ; and that my <br />name appears in Block 10 or Block 11 if <br /> changed , or on an attachment wit a d ss , it r like empo red . <br /> J . RICHARD GRAVES , JR . 01 - 13 -03 772 - 589 -4356 <br /> SIGNATURE • <br /> SIGNATURE AND TYPED OR PRINTED NAME OF SlAfiING OFFICER OR DIRECTOR Date Daytime Phone a <br />