282-Citizens & Southern Trust C
MAIL LOSS AFFIDAVI~
Details ~f Shipment
Mailed by: (Sender) Interstate Securities Corporation
2700 NCNB Plaza
Place of Mailing: Charlotte, NC 28280
Date: September 19, 1986
Mailed to: (Addressee) Florence L. heals
1910 S E 18th Street
Pcrnpano, Beach, FL 33060
Certificate or Bond No.(s) and
Number of shares or principal
amount of bonds and/or coupona: 0679 ($10,000)
Corporation or [ssuer: Sanford Florida Water & Sewage l~ev Ambac
Reg-D, 7 3/4% Due 10-1-05
Cla~s o{ Stock or
description of Issue: Muni Bond
Registered in name of: Florence L. Beals
If endorsed, indicate here:
AFFIDAVIT OF MAILING
STATE OF: North Carolina
COUNTY OF: Mecklenburg
The underSigned, deponent, being first duly sworn, deposes and says that, in accordance with the ll~or(l. el the
above named Sender, the above described securities were [orwarded 5y United States Mail on the date spec{fie~ i~ a po~[.
paid envelope addresse~ to the above named Addressco. The said Addressee has reported the non.delivery o[ the
s~curkles. The securities have not been returned to the above named Sender and they are be[loved to have bee~
destroyed in the malls.
Deponent agrees on behalf of above named Sender that if the securities should ever come into their hand~,
or power, deponent will immediately surrender the original securities for cancellation.
· %idacare here whether deponen~ ~s ~/~/.~..~/o/~~
partner or emp oy of 50k 'aV e
Set~der.
~:' ~ Vice President 2700 NCNB Plaza, Charlotte, NC 28280
!' ' SubsCribed and sworn to before me this 3 day of February ,19 87
(Indicate date c es) t '
STATE OF: F"t c,c'~ ~a A{~FIDAVIT OF NON-RECEIPT
COUNTY OF: or-, d.a-
The undersigned deponent(s), being' first duly swo~n depose(s) and say(s) that the above described ..~eurifies
have never been received by the above named Addressee or any person or persons acting on (its) (his) (her}
behalf. Deponent(s) agrees (on behal/of the above named Addressed that if the securities should ever come into (hlsl
(her) (its'l (their) custody or power, deponent(s) will immediately notify the above named Sender and will surrender
the original securities £or cancellation.
or employee. '
~ '" '(i-[mo~ than one addressee or
· I-- ' ~e~3ered owner, all must sign)
- , seribedandsworntobe,oremetbi, dayo
· '~/~ 'gg6L '~Nnr ~o Ave HlOE ~Mi ~0 SV ANVdNO3
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