ECEIVED BY SERVER DATE 0 Sh719 1-OO t V PLACE - W ee FL SERVED DATE OeSit Cl/2-00 itr PLACE ie FL 1A/P SERVED ON (PRINT NAME rover) RV IDDITIT NIA MG% I TITLE 1:.1-e.C.,1 0,1 ArCh STATEMENT OF SERVICE FEES TRAVEL SERVICES TOTAL 0.00 DECLARATION OF SERVER P) I declare laws - ' ' " ' •