HomeMy WebLinkAbout126 Pinefield Dr (2)Phone: % 2 7 —6 3 7- t 100 Fax:
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I E3 q
Documented Construction Value: $ G 060
Job Address: 12 6 ri X r£�i c l j �%Q. Historic District: Yes ❑ No ❑
Parcel ID: 31- " - - S S" vv oo ' 1 () Residential ❑ Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair R Demo ❑ Change of Use ❑ Move❑
jr1/
Description of Work: e.h v v c w l e'e l9-eL 2 yT�' /��i/�t�� S%NYl s
Plan Review Contact Person: T�.-. t���tr/'`�{y Title:
Email: t:k— • dA Wet dZ ts,r�oe.�: f��t•�.�. f'�i
/ Property Owner Information
Name Phone: to 7- WV 8S 77
Street: 12- I i #1,0 ��- Resident of property?
City, State Zip: _('A,.y �o ti �- �L 2 7 7
Contractor Information
Name �� e : e�L �� o o �� nl 5 CA�t��xtn.7 Phone: `IO 7 - S 78 " 6 l 3
Street: S Lo C"ti i c y ill Fax:
City, State Zip: DAi 1- N ci+LAC '3 L 80 `f
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
State License No.: << C O S` 7 5 1 y
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction
in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 511 Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be
found in the public records of this county, and there may be additional permits required from other governmental entities such as water
management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in con)pliance with all applicable laws regulating construction and zoning.
Signa a of �Owner/Agent
Date
4O� ` 7L
Print Owner/Agents Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
,-2— 2- Z2 14�4_
Signature of Contractor/nDate
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Anent is Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas ❑ Roof ❑
Construction Type: Occupancy Use: Flood Zone: -
Total Sq Ft of Bldg:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015
Permit Application
THIS INSTRUMENT PREPARED BY:
Name: Premiere Roofing and C rpentry
Address: r a.
NO ICE OF COMMENCEMENT
Permit Number:
Parcel ID Number: 32`IQ "31 -'Jt 5 -0"Ou -OA 30
GRANT SENIidOLE COUNTY
'CLERK OF CIRCUIT COURT & COMPTROLLER
CLERK'S 201E019989
RECORDED 02/21='201S 11:27:37 All
RECORDING FEES $10.00
RECORDED 1.''Y hdevore
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DESCRIPTION OF PROPERTY: (Legal descri tion of th property and street address if available)
�el«v�al�as �hat�� OF' (02 ass ;�s-z6
2. GENERAL DESCRIPTION OF IMPROVEMENT:
Re -Roof
3. OWNER INFORMATIO OR LESSEE INFORMATION IF THE LESSE CONTRACTED FORE IMPROVEMENT:
� a(-. Pin �c(dC O� Sa raL, ►°� 32Z
Name and address: ,etlic GAS
Interest in property: 9f^ r
3_2_
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: Premiere Roofing and Carpentry Phone Number: 407-578-6893
Address: 5611 Carder Rd Orlando, FL 32804
5. SURETY (If applicable, a copy of the payment bond is attached): Name:
Address:
6. LENDER: Name: Phone Number:
Address:
Amount of Bond:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as provided by Section
713.13(1)(a)7., Florida Statutes.
Name: Phone Number:
S. In addition, Owner designates
of
to receive a copy of the Lienot's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number:
9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE
JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
I4L
State of
County of ('e
The foregoing instrument was acknowledged before me this Y day of
if,a
by _ 'e Y/& e- 1-0— . Who is personally known to me ❑ OR
Name of person making statement
who has produced identificatiorQ1 tonype of identification produced:
.-RTIFIED COPY GRANTIv
.ERK OF THE CiRQJIT COU
40 C011(4PTPr)l i fD- \
Jonathon Thomas
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG141189
&Fxeires 9/18/2021
Notary signature
20)%—
to DEPU"f'r 0.i:RK
i remiere Roofing and
fry
Above all, it's a Premiere job?'
This contractlagrreement describes the scope of work for your property:
ROOFING SPEC[ FICA CiONS
�..//�
�1 ear off roof coverings areas: Sloped Flat
ft,
L .%Pnrade surcharge: S L or ,._
u Inspect roof deck. Re -nail up to code.
Install new fibergg ass shingles: 3 1. Architectural
JDn- in with uncle is}mzni paper.
braid cr Style:
i�✓'/�Ihstallnew 'Metal arvalleys, dripandra edges.
"Color tr'&l lt`:vtj
14',,1,iistall all new Plumbing stack flashings.
TrrsLall a iIModincd B Lumen Membrane Roof System.
_, Install new gooseneck roof t Brits.
Solar Panels: _ _ ea. D&R R&R
P'lnstal,I new attic roof cents:
SkVi ahts Flash.n s: D&R R&R
Others:
Skylights: MR, R&R
SCRFFNS / LAN.AI SPECIFICATIONS
u .Replace screens- wails Roofs _...___........
0 Enclosure Super Gutiers: - LF. D&R R&
GUTTERS SPECIFICATIONS
S1 ...I C,ut erS: LF MR R&R
R _ 1)rnvnspouts:
LJ Lnelk)sure Framc. D&R R&:R
D Others: Others:
INTERIOR SPECIFICATIONS
Ceilings T=Texture. R- Repair PT'ainting
_ Wallsv T-Teriure R-Repair P Painting
❑ Flooring
1] Others: _
1,3ftC:' wood Tile
L.F. M,R MR
{v` q— dejit"Le.P;d
CLARIFICATIONS:
I. THIS CONTRACT IS FOR ALL WORK. TO BE PERFOILN'lI D By PRC AS PER SCOPE OF FORK, AND
PROCEEDS FROM INSCIRANCE. COMPANY UNLESS OTI-TER%1VISL STATED.
1 Ow-ner responsible for Late and Ordinance / Rotted wood ifoot covered bvinsurance company.
3. If it. becomes necessary to de kh and reinstall gutters. PRC CANNOT BE RESPONSIBLE. FOR THE FINAL
CONDITION OF THE GUTTERS.
4. Deteriorated or unsuitable wood members to be replaced it needed it an additional cost as follows:
=. Sheathing: S 75.00 per sheet of plywood ; S 1.50 per LF up to :I x:, . S 5.50 for 1 xl 0 and 1 x 1=.
b. Fascia and Structural Wood member 7:50 per LF {no paint ncludcd}.
STANDARD FEATURES
PRC to furnish labor and materials.
:• PRC to furnish building permit as necded. All work to contcarrn to today `s local building codes.
. General clean up and haul off all work rcl3ud debris t c m property.
PRC provides the foho�.'ns workmanship warran4tie s Roof 4-years All others: ]-year
PAYMENT TERMS: 1..hc Owner°s deductible due upon acceptauice and signing, ofthis contract.
1/3 On Commencement. day: Payment of completed trade; Balance on Completion.
F221 5611 Carder Rd.; Orlando, FL 3381.0 Tel. 407-57ii-6NY3 tax 4v 1- lvo-avo r
L c. ri CCC 057159-
Premiere Roofing and
"Above all, it's a Premiere iob!"
POWER OF ATTORNEY
To: r Date:
I hereby name and appoint Team K- 5 Brian Kirby; Tim O'Malley; Aaron Hallich; Frankie
Jamarillo; Eric De Dios and David Weed to be my lawful attorney in fact to act for me and
apply for a Roofing permit to be performed at a location described as:
Section Township Range Lot Block Subdivision
Parcel ID: ,7-/q-31-S/S-00CG0-0(so
Project Location IP61 eon i& a or
Owner's Name 14ym n 12
Owner's Address ri7 D .
And sign my name and do all things necessary to this appointment.
Signature of Contractor J4�`
It
Michael A. Morgan C057594; CBC056687
Acknowledge:
Michael A. Morgan is personally known to me.
Sworn and subscribed before me this day of f 6 , 209,
Notary Public, State of Florida
YAss Jonathon Thomas
o� NOTARY PUBLIC
My commission expires -STATE OF FLORIDA
'0 Comm# GG141189
E 19�® Expires 9/18/2021
5611 Carder Rd., Orlando, FL 32810 Tel. 407-578-6893 Fax 407-704-8967
F120 Lic. # CCC-057594 www.prcroofservices.com
SCPA Parcel View: 32-19-31-515-0000-0130
Page 1 of 2
Property Record Card
CTA
Parcel: 32-19-31-515-0000-0130
r_m«wry wtzx� Property Address: 126 PINEFIELD DR SANFORD, FL 32771
Value Summary
2018 Working 2017 Certified
Values Values
ValuaValuation Method
tion
Cost/Market Cost/Market
9.
...w,...._...,_...,, ,
Number of Buildings
., _ __ ... ..., _. .......�:..,__....,,......_ . _
1 1
Depreciated Bldg Value
$140,457 $132 374
Depreciated EXFT Value
$1 339 $1 401
Land Value (Market)
$32,500 $32,500
((( Land Value Ag
........... ...._...
........
Just/Market Value'"
$174,296 $166,275
Portability Adj
�.
Save Our Homes Adl
$69,547 $63,680 '
i Amendment 1 Adl
$0
P&G Adj
$0 $0
I Assessed Value
.......
$104,749 $102,595
Tax Amount without
SOH: $2,378.27
2017 Tax Bill Amount $1,165.72
Tax Estimator
Save Our Homes
Savings: $1,212.55
Does NOT INCLUDE Non
Ad Valorem Assessments
Legal Description
LOT 13
CELERY LAKES PHASE 1
PB62PGS75&76
Taxes
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
$104,749
$50,000 !
$54,749
Schools
$104,749
$25,000 ,
$79,749
City Sanford
$104,749 .
$50,000
_
__.. __ ___
$54,749
SJWM(Saint Johns Water Management)
$104,749
$50,000
$54,749
County Bonds
$104,749
$50,000
$54,749
Sales
Description mm-j
Date l Book
Page _ Amount
I Qualified
Vac/impT
_....__.._
SPECIAL WARRANTY DEED
12/1/2003 05156
1404 $133,500
Yes
Improved
T
find Comparable Sales
Land
Method Frontage
( Depth Units
Units Price
G Land Value
1 LOT
1 ' $32,500.00 ;
$32,500
Building Information
Is Bed/Bath count incorrect? Click Here.
( Year Built
# Description i Fixtures ! Bed Bath :. Base Area Total SF Living
SF Ext Wall Adj Value
Repl Value
Appendages
Actual/Effective
1 1 SINGLE 2003 9
3 2.5 1,120 2,659
2,215 CB/STUCCO '' $140,457
' $147,849
............... -
f Description Area
FAMILY
FINISH
GARAGE
420.00
FINISHED
24.00
http://parceldetall.sepafl.org/ParcelDetailInfo.aspx?PID=32193151500000130 2/13/2018
CITY OF
S.�NFORD
PERMIT # ' & / � Q
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: 126 Pinefield Dr.
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: 4REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY): 1 /2" Plywood
* *PLEASE NOTE: ONL Y 100 SQUARE FEET OF THE EXISTING DECK IS PERMITTED TO BE REPLACED""
ROOF VENTILATION: D OFF -RIDGE RIDGE 0SOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES 4No IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
-----------------------------------------------------------------------------------------------------------
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12-4:12 (,%D 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
ar
SHINGLE
GAF
FL# 10124.1
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
OTHER: Underlayment
GAF
FL# 18686.1
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **_fFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12-4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGLE
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
CITY OF
Building & Fire Prevention Division
Slk�40RD RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE PEPARTtAENIT
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
**PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
• PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION
• COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
• COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
• ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
(PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
• DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
• SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WELL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: --2-- DATE: 2 L //S
SCPA Parcel View: 32-19-31-515-0000-0130
Page 1 of 1
David u
tsmon, CFA
R
seMaxxc ccxs+rv, r4pcunr.
Property Record Card
Parcel: 32-19-31-515-0000-0130
Property Address: 126 PINEFIELD DR SANFORD, FL 32771
http://parceldetail. scpafl.org/ParcelDetailInfo.aspx?PID=32193151500000130 2/21 /2018
C117y OF
SA�NFORD Building & Fire Prevention Division
_�_--- RESIDENTIAL RE -ROOF AFFIDA VIT
fla D T
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: l O'er Qi Z
ADDRESS: 126 Pinefield Dr.
FL 32771
I Michael Morgan , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE #: CCC057594
COMPANY / CONTRACTOR: Premiere R000 nq -and Carpentry
CONTRACTOR SIGNATURE: ,/��%� DATE: (,:n
(MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUI R)
A FINAL ROOF INSPECTION IS REQUIRED:
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
**FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF SE+ 1 VX1_ 6—
Sworn to and Subscribed before me this day of %7V,J9 20 by:
U C - , O(Z-u A-� Who is P'P'e'rsonally Known to me or has ❑ Produced (type of
identi c tion) as identification.
:�a"• SUSAN C TURNER
Signature of Notary ,Public MY COMMISSION # GG007357
State of Florida =.EXPIRES June 29, 2020
(407) 39"153 FloridalloteryServicex=
S' L) "�� e I k 0
Print/Type/Stamp Name
of Notary Public