RECENED A 
. 96 1 any 

ga-Re {he Foffeihne of-
ist th SEIZURE 
0W are claiming) I 0
. Q, ammo--Mm?

CLAIM

Tlieundersigned ii! 3650C 
. . files this Verified Claim under oath
SBekmg to claim Ins/her mm the above listed asfollows:


.1) NAME OF THE CLAIMANT: 5 62m 

2) CLAIMANT ADDRESS FOR ACCEPTANCE OF MAIL:

  
 

Street Address:
City, 31853) Zip
Phone Number.

Tnimmomzfi


SOUGHT TO BE 

  
  
 

   

    

- f/x elf/um 
. . h- A ,1OFTgIEgRoymwr: (W110 QAVE you 1112; -
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.