PTO Form 1553 (Rev 9/2005)
`
`OMB No. 0651-0054 (Exp. 09/30/2011)
`
`Trademark/Service Mark Statement of Use
`(15 U.S.C. Section 1051(d))
`
`The table below presents the data as entered.
`
`Input Field
`
`Entered
`
`SERIAL NUMBER
`
`77798851
`
`LAW OFFICE ASSIGNED
`
`LAW OFFICE 107
`
`EXTENSION OF USE
`
`MARK SECTION
`
`STANDARD CHARACTERS
`
`USPTO-GENERATED IMAGE
`
`OWNER SECTION (current)
`
`NO
`
`NO
`
`NO
`
`NAME
`
`STREET
`
`CITY
`
`STATE
`
`ZIP/POSTAL CODE
`
`COUNTRY
`
`OWNER SECTION (proposed)
`
`NAME
`
`INTERNAL ADDRESS
`
`STREET
`
`CITY
`
`STATE
`
`ZIP/POSTAL CODE
`
`COUNTRY
`
`GOODS AND/OR SERVICES SECTION
`
`INTERNATIONAL CLASS
`
`CURRENT IDENTIFICATION
`
`GOODS OR SERVICES
`
`FIRST USE ANYWHERE DATE
`
`FIRST USE IN COMMERCE DATE
`
`SPECIMEN FILE NAME(S)
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)ORIGINAL PDF FILE
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)CONVERTED PDF FILE(S)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(3 pages)
`
`Salt Life Holdings LLC
`
`Suite 300
`
`Jacksonville
`
`Florida
`
`32246
`
`United States
`
`Salt Life Holdings LLC
`
`Suite 300
`
`13051 Beach Blvd.
`
`Jacksonville
`
`Florida
`
`32246
`
`United States
`
`043
`
`Restaurant and bar services
`
`KEEP ALL LISTED
`
`01/04/2010
`
`01/04/2010
`
`SPN0-209296162-170807419_._Salt_Life_menu_specimen.pdf
`
`\\TICRS\EXPORT10\IMAGEOUT10\777\988\77798851\xml1\SOU0002.JPG
`
`

`
`SPECIMEN DESCRIPTION
`
`REQUEST TO DIVIDE
`
`PAYMENT SECTION
`
`NUMBER OF CLASSES IN USE
`
`SUBTOTAL AMOUNT [ALLEGATION OF USE
`FEE]
`
`TOTAL AMOUNT
`
`SIGNATURE SECTION
`
`DECLARATION SIGNATURE
`
`SIGNATORY'S NAME
`
`SIGNATORY'S POSITION
`
`DATE SIGNED
`
`FILING INFORMATION
`
`SUBMIT DATE
`
`TEAS STAMP
`
`\\TICRS\EXPORT10\IMAGEOUT10\777\988\77798851\xml1\SOU0003.JPG
`
`\\TICRS\EXPORT10\IMAGEOUT10\777\988\77798851\xml1\SOU0004.JPG
`
`scanned copy of menu showing the mark in use
`
`NO
`
`1
`
`100
`
`100
`
`/thomas c. saitta/
`
`Thomas C. Saitta
`
`Attorney of record, Florida bar member
`
`04/06/2010
`
`Tue Apr 06 17:15:34 EDT 2010
`
`USPTO/SOU-XXX.X.XX.XXX-20
`100406171534258413-777988
`51-460a15b95d41ff04c07232
`f33ff3156c73-DA-3571-2010
`0406170807419026
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`

`
`PTO Form 1553 (Rev 9/2005)
`
`OMB No. 0651-0054 (Exp. 09/30/2011)
`
`To the Commissioner for Trademarks:
`
`Trademark/Service Mark Statement of Use
`(15 U.S.C. Section 1051(d))
`
`MARK:(cid:160)SALT LIFE (stylized and/or with design)
`SERIAL NUMBER:(cid:160)77798851
`
`The applicant, Salt Life Holdings LLC, having an address of
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Suite 300
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)13051 Beach Blvd.
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Jacksonville, Florida 32246
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)United States
`is submitting the following allegation of use information:
`
`For International Class 043:
`Current identification: Restaurant and bar services
`
`The mark is in use in commerce on or in connection with all goods or services listed in the application or Notice of Allowance or as subsequently
`modified for this specific class
`
`The mark was first used by the applicant, or the applicant's related company, licensee, or predecessor in interest at least as early as 01/04/2010,
`and first used in commerce at least as early as 01/04/2010, and is now in use in such commerce. The applicant is submitting one specimen for the
`class showing the mark as used in commerce on or in connection with any item in the class, consisting of a(n) scanned copy of menu showing the
`mark in use.
`
`Original PDF file:
`SPN0-209296162-170807419_._Salt_Life_menu_specimen.pdf
`Converted PDF file(s) (3 pages)
`Specimen File1
`Specimen File2
`Specimen File3
`
`The applicant is not filing a Request to Divide with this Allegation of Use form.
`
`A fee payment in the amount of $100 will be submitted with the form, representing payment for the allegation of use for 1 class.
`
`Declaration
`
`Applicant requests registration of the above-identified trademark/service mark in the United States Patent and Trademark Office on the Principal
`Register established by the Act of July 5, 1946 (15 U.S.C. Section 1051 et seq., as amended). Applicant is the owner of the mark sought to be
`registered, and is using the mark in commerce on or in connection with the goods/services identified above, as evidenced by the attached
`specimen(s) showing the mark as used in commerce.
`
`The undersigned, being hereby warned that willful false statements and the like so made are punishable by fine or imprisonment, or both, under
`18 U.S.C. Section 1001, and that such willful false statements may jeopardize the validity of the form or any resulting registration, declares that
`he/she is properly authorized to execute this form on behalf of the applicant; he/she believes the applicant to be the owner of the
`trademark/service mark sought to be registered, or, if the form is being filed under 15 U.S.C. Section 1126(d) or (e), he/she believes applicant to
`be entitled to use such mark in commerce; to the best of his/her knowledge and belief no other person, firm, corporation, or association has the
`right to use the mark in commerce, either in the identical form thereof or in such near resemblance thereto as to be likely, when used on or in
`connection with the goods/services of such other person, to cause confusion, or to cause mistake, or to deceive; and that all statements made of
`his/her own knowledge are true; and that all statements made on information and belief are believed to be true.
`
`

`
`Signature: /thomas c. saitta/(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Date Signed: 04/06/2010
`Signatory's Name: Thomas C. Saitta
`Signatory's Position: Attorney of record, Florida bar member
`
`RAM Sale Number: 3571
`RAM Accounting Date: 04/07/2010
`
`Serial Number: 77798851
`Internet Transmission Date: Tue Apr 06 17:15:34 EDT 2010
`TEAS Stamp: USPTO/SOU-XXX.X.XX.XXX-20100406171534258
`413-77798851-460a15b95d41ff04c07232f33ff
`3156c73-DA-3571-20100406170807419026
`
`

`
`TEASERS
`EAHAMIAN BDNDH GHDWDER
`I::uI=- 3.49
`aI:IwL 6.99
`AN |5LAND'STYLE I=AvcInrrE.
`
`5.99
`FRIED EIALAMARI
`LIEHTLY FRIED WITH LEMDN AIEILI.
`
`2.99
`SHACK FRIES
`FRENBH FRIES EEAECINED AND SERVED
`WITH CDSTA RIGAN D|F‘PN' SALIBE.
`
`3.99
`BI.AI::I< BEAN DIP
`WITH I::I:IRN TEIFITILLA 1:HIPs.
`
`ENIEIKED CHICKEN QIJEEADILLA 6.99
`GRILLED FLOUR TEIRTILLA STUFFED WITH
`CHEESE. PEPPERS, PIED, BILANTREI, EINIBN5
`AND OUR BEER BAN CHICKEN.
`
`7.99
`SHRIMP AND IJHIZIRIZEI NAI::HI:I5
`GRILLED SHRIMP AND cnumzn TEIPPED WITH
`cunu. EI.AI:I< BEANS. JACK AND GHEDDAR
`I:HEEs:-:,
`I=u:.-cu AND FINISHED WITH A CILANTREI
`LIME EREAM DRIZZLE.
`
`2 SKEWERE (1 El] 7.99
`
`4.49
`
`WINEE
`1 SKEWER (5)
`HAWAIIAN
`ISLAND'5MCIKED. FRIED AND TEISSED WITH
`EILIR HAWAIIAN 5AuI:E.
`EEAI::H5IDE Burl-'AI.I:I
`EHADK SEIIIRET SPICE, FRIED AND TEIEEED
`WITH EILIR WINE EAuI::E.
`EHABK BLACK
`FRIED THEN BLAEKENED.
`
`....ICO...
`
`(We;
`
`FOOD SHACK
`
`RAWBAR 8. SUSHI
`HLITTI:I’s I3EVI::HE**
`5.99
`"FRESH EIFF THE DDI::I(" FISH WITH CINIIJN,
`PEPPERS AND TDMATIZIES IN A LIME MARINADE.
`
`CIYSTERE EIN THE HALF SI-IEI.I.* B.99
`DCIZEN CIYETERS RAW EIR ETEAMED.
`SERVED WITH GEIEIKTAIL AND HUREERADISH.
`
`6.99
`BHARERILLED CIYEITER5
`HALF A DEIZEN FRESH EIYETER5 BHARERILLED
`|N A DEL|I2|ElLI5 GARLIC: BUTTER SAUCE TDPFED
`WITH FARMEEAN.
`A BLI::I<!.
`EIYEITER E'IHI:II:ITER*
`SINGLE SHEIT EIF CINE RAW DYSTER, BEER,
`COCKTAIL SAUCE AND SOME HEAT-
`
`6.99
`TUNA RlZ|I..L**
`TEMPLIRA FRIED TUNA I=I:n<E, AvI:IcADI:I AND
`EILIGIJMBER WITH WAEIAEII DREAM.
`
`5.99
`SHRIMP RCILL
`EEAEEINED EEARED SHRIMP, AVEIDADI3,
`I::uI::I.IMEER AND EIARREIT5 SERVED WITH
`EEI_ sAuI:E AND WAEAEI DREAM.
`
`4.99
`BEINSAI BALAMARI
`GALAMARI MARINATED WITH SESAME. WAEABI
`AND GINGER EIVER WA!-(AME IEEAWEEDI EALAD.
`EDAMAME
`3.99
`EIAIJTEED AND BEAEEINED WITH SEA SALT.
`
`_
`
`.9 R-I:I.I::—I<N’ S. REILLN’ MIZINVDAYSV ,
`,sTEAI'vIED MAYPIEIRT SHRIMP -DR SNDW-‘~“:
`.
`l3RA‘9'L_E'E‘:9“‘\I'\II'I'H"A_'SlI;II.-_Z‘
`l‘3_I-“EI_l:Z_II-'s'N $1 1'._9"9_f
`'
`i$2' CDREINAE A_NI:-IRED STl'-'\'l'P'E5'4“- "FMH 1'ILfI:I..I:IsE
`I 'FLA5‘H'BIAi=kII‘F”uIEéDAY_S
`=
`F"?‘!YI"N'3. sum 9»
`
`
`
`I-‘I:Iu_r'4::I.L's.-'riI:I.r~I. —A"
`j‘_EUFF:'EI=R“I"‘TI-II:'.‘I;I‘_'IC:AL NJ-‘II
`-VPEIRTIDN I:II-" f5A‘I.Es :3I:I‘E’E. T_I:I _E_.I_._I_'_I=Ij=_i:IIa_'_I_"'r:-II_ea
`HVJDIQGANIZATIDN AND I1"5'I::I:IM.M.uN_1Tj< VF‘-RI2'IER:A_‘b_/IS. C '
`V
`DII~I-NEn'.aI=Ec:IALsf:FE-AT:ILiI:IED
`‘
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`I GEIMIN I3 51:: E:|.N-J
`9-
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`I-'I_VlI-',-"I-_LI_;.|_F" "I-“,R'.I:D‘Aj’rE'I
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`EI=EI:IALs_ >'_-:_HA‘PP>Y I-I,I:|I.I,IE1.j'rjI7I,I1_I.I,*rHE-_I9III3H-I-.;
`'2
`
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`
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`
`_
`
`T.
`_‘_‘_‘i!II-EIEI-‘I_‘U‘_N‘7I; 9ATuRI’::A’YsW_,7
`M
`‘ FEfi§‘fI.I:RI‘N'fi DINNER‘ S_F"Erl.1'l,AI;§.' DLIR ‘lrL‘HEFE’f-_
`"FR_ES_H _E_|I-‘F’ THE DI:IE::I<'"f FISH l;RE_A‘I'_IDNE.
`V
`
`'
`
`W ~.E‘AI::I<yA'RD 5ILII\ID_AYS:
`_
`BEER I:AjI~'I'I::I‘-IIr:I<EI~I $E.j'.=r9 _
`-
`.
`I $2’ 161:: PBR cans, AND ‘$4..+£BLI::i_:3vs-- 2
`V
`“
`'ALI.bAYI
`'
`—
`‘
`
`_,
`
`2
`
`

`
`COASTAL GREENS
`SEARED AHI TUNA SALAD*"
`‘IELEI9
`SEARED AHI TUNA TDSSED WITH REIMAINE
`L:'r'ruc:I—:. TOMATO, AVOEADD, GAEIEABE,
`GARRDT5,
`|::RI5r-"r RICE NOODLES AND
`TDAEITED ALMCIND5. FINISHED WITH EEEAME
`EDY DRESSING AND SWEET CHILI AIULI.
`
`9.99-
`GDETA RIIJAN SHRIMP SALAD
`ETEAMED IHAYPEIRT SHRIMP, HEARTS DP‘ PALM,
`AVEIGADEI; TC-IMATCIES AND GREEN CINIONS WITH
`IEIEEERE AND RDMAINE. FINISHED WITH FDEID
`SHACK HDLIEE DRESSING.
`
`EL99
`EAJA EIHIEIKEN SALAD
`rm:-RuAs-ran PEPPERS, IZINIDNE, PCIRTABELLA
`MUSHROOMS. CORN AND TOMATOES. EEASDNED
`WITH GILANTRCI LIME FEEITD. TOPPED wn-H
`WOEIDIERILLED GHIBKEN BREAST. FINISHED
`WITH GHIPOTLE nnassum.-1.
`
`9.99
`WEIDDGRILLED DEIRADEI CAESAR
`SEASDNED MAHI WITH BRILLED nmmqs AND
`PEPPERS sznvzn OVER A cLAssn: CAESAR EALAO.
`
`HAND I-IELDS
`ALL HAND HELDS ARE SERVED SEILCI
`
`5.99
`BACKYARD EDRI:-1|-:R**
`A SIGNATURE WDCIDGRILLED BURGER SERVED
`WITH LETTLIBE, TOMATO, CINIEIN, FIDKLE AND
`nun SHACK SAUCE.
`
`6.99
`BURGER GLUB**
`AF-FILEWDDD BADDN, HAM, DHEDDAR GHEESE,
`LETTLICE, TOMATO AND MAYO.
`'
`TURKEY BURGER
`5.99
`A BLEND DI-' TURKEY, DNION3, IIIELERY, PEPPERS
`AND EEEIRET SPIDER TIIIPFED WITH GILANTRD
`FEETIII AND MELTED PROVCJLDNE GHEEEE.
`
`6.99
`TREIFIBAL YARDIRD
`EEINELEEB DHIGKEN BREAST WIZIODIBRILLED
`AND TI:n=-F-ED WITH DRILLED PINEAPPLE AND
`FRDVEILDNE. DRIZZLED WITH MAPLE-SCIY
`BLAZE AND HDNEY MUSTARD.
`
`5.99
`FISH SANDWICH
`MAHI LIGI-ITLY EEAEIIJNED WITH “SHACK ELABK"
`EEAEEININGS, WEICIDIERILLED AND FINISHED WITH
`A BILANTRCI LIME AND RED PEPPER AICILI.
`
`7.99
`SOFT EH1-:LL GRAB ELT
`SOFT SHELL GRAB DLIETED, FRIED AND
`DRIZZLED WITH OLIR EHAEIK EALIDE. SERVED
`ON IZIIABATTA BREAD WITH SHREDDED LETTLIBE,
`TOMATOES AND CRISP AFFLEWDDD BACON.
`
`7.99
`EAST CICIABT SHRIMP ROLL
`EEAEONED FRESH SHRIMP EALAD SERVED
`ON A TOAETED ROLL TOPPED WITH MELTED
`HAVARTI EIHEEBE.
`
`5.99
`GRILLED VEGEIE SANDWICH
`GRILLED PORTAEELLA MUSHROOM. FIRE‘
`ROASTED RED PEPPERS, ONIONS AND
`MELTED HAVARTI ON GIABATTA BREAD.
`
`5.99
`KILLER KIELBASA DOE-I
`HALF POUND DRILLED EAIJEABE DDD EIERVED
`EIN A TEIASTED ROLL WITH DMDN MUSTARD
`TOPPED WITH ENSENADA DAEEAGE aLAw.
`TWEI HANDS RERILIIEED.
`
`* THERE IS A RISK ASSOCIATED WITH GEINSUMINE EAW
`CIVSTERS. IF YOU HAVE A EHREINIE ILLNESS EIF THE LIVER,
`STUMAGH OR ELODD. OR HAVE IMMUNE DISORDERS, YOU
`ARE AT GREATER RISK FDR SERIEIUE ILLNESS FREIM RAW
`CIYETEHS AND EHEILJLD EAT UYSTERE FULLY DDEIKED.
`IF
`LINSLIRE CIF YCIIJR RISK,
`IZEINSLILT A PHYSICIAN.
`‘X'I' EUNSLIMF-'TlDN DF TUNA. EHDIJPER CIR HAMEIJRGER
`THAT IS HAW DR IJNDERCGEIKED MAY EIGNIFIGANTLY
`INCREASE THE RISK ASSOCIATED WITH EEHTAIN
`ESPECIALLY VULNERABLE
`CONSUMERS
`EATING
`EUEIH FDEID5 IN RAW IJNDEHGUEIKED FURNI.
`
`

`
`THE HOOK UP
`7.99
`ENSENADA TACD
`WDUDERILLED MAHI WITH ENSENADA GAEEAEE
`SLAW, SHREDDED GHEESE. FIEID AND DRIZZLED
`WITH GILANTREI LIME GREAM EALIGE.
`GARLIC SHRIMP
`12.99
`WDEIDEIRILLED WHEILE SHRIMP, DRIzzLED
`WITH A SARLII: LEMDN DIL SERVED WITH
`VESBIES AND FRIES.
`13.99
`ISLAND STYLE RIEIS
`BABY BACKS sI_Dw SMOKED, FINISHED cm
`THE wI:II:ID GRILL WITH AN ISLAND-STYLE BBQ
`GLAZE. SERVED WITH TFIDPIIIIAL FRIED nII:E.
`CHICKEN TENDERS
`7.99
`JUICY CHIGKEN TENDERS FRIED BRIEFY
`WITH EUR I-IDNEY MUSTARD DIF'FN' SAUCE.
`SERVED WITH FRIES.
`
`9.99
`FRIED LI:II:AL SHRIMP
`FRESH EHRIMF FRIED GDLDEN WITH
`FRIES AND SIGNATURE SHACK SAUCE.
`I:IALIE:HE'5 PEIKE BflWL"'
`I4-.99
`STRAIEHT FRDM WISHBDNES IN PLAYA IJAUD —
`FRESH TUNA SEASDNED WITH I3ALIl3HE'S
`SECRET MARINADE SERVED WITH STEAMED
`EFINAGH DVER STICKY RIIZIE. TIZIFPED WI‘I'I-I
`DIGED AVDBADD AND GREEN EINIEIN. PURA VIDAI
`
`9.99
`GREIUFER FINGERS
`FRIED SRDLIF-ER SERVED WITH FRIES AND
`TARTAR SAI.II:E.
`
`14.99
`5HAI::I< FISH
`DLIR I2APTAlN'5 cHI:m::E DF FRESH-GALIGHT
`FISH PREPARED UNE OF OUR SIGNATURE WAYS.
`ASK YEIUR SERVER ASDUT Tl:IDAV’S GHDICE.
`WDDDGRILLED SALMDN
`I3.99
`MARINATED sI.I:Iw-sMI:II<ED SALMDN. GRILLED
`WITH A MAPLE-BEIY BLAZE. SERVED WITH
`TROPICAL FRIED RICE.
`BEASH E|I:IIL
`I 1.99
`SHRIMP, Snow ERAS LESS, SALISAI:-IE,
`BURN, CINIEINE AND FDTATDEE EERVED
`IN CIUR SEASDNED SDIL.
`
`10.99
`PAN-SEARED I'::HII::I<EN PASTA
`FANKIJ GRIJSTED IJHIBKEN TDFFED WITH
`FIRE'RDAETED TDMATEIES AND A LEMEIN SAFER
`BUTTER: SERVED WITH FETTUBBINE IN A BAEIEIN
`PAFIMEEAN CREAM SAUCE.
`
`BACKYARD BEER BAN I:HII::I<EN
`DLIR I::I:IASTAL VERSIDN DF “EEER CAN"
`CHICKEN, SLEIW SMEIKED AND FINISHED WITH
`EILIR MAFLE'EDY ELAZE. SERVED WITH ERILLED
`GDRN EIN THE GDEI.
`
`9.99
`
`FIRST MATES
`AGES I2 AND UNDER
`ALL ITEMS SERVED WITH FRIES
`
`FRIED SHRIMP
`UHIDKEN TENDERS
`KID BURGER
`
`BHEESE RIUESADILLA
`CIZIRN DDG
`
`4.99
`3.99
`3.99
`3.99
`
`3.99
`
`Efllfe,
`
`,_-.,LT LIFE" I:IRII3IN.:.TI:D IN
`._I.—1uI SLII~I\JILLL E!I:,uI_:H WHERE LIVING THE
`LIFE‘ IS V‘./H='\T "WE ARE RASSIIJI-IATE AEIFJIJT.
`TIIIE. _-ZIMFLE PIIRAEC EII‘-IEE L.ITTEI'3.I_'.D CIN .I'\
`EIF'E.«1.RFIEI|lI‘\lG TPIP I13 I‘\ICI\.V A ‘."."lDEL‘v'
`I-'.EI_JUl_iNl_'I-_L’ SUE:-L:LILII_II<r_ Ar-IIn.~—:I AVIII
`|')I\./F_|'«.“=I, SIIRFERS AND FISHERIIEII.
`ITS A
`rm.’ Dr LIFE, Eli-IE TIIIAT Ar-Iv IV/\TI:l'~!I‘.I/‘xfl,
`LIH \.‘.'LII-IAN,
`‘-.I..|_IIJLD EIE F-RCILJE: TI:I EIE
`F';=.I3.'I' CIF. II":3 YLIUR LIHLIILIE L|I-
`I-LII-I‘
`F|_l‘II"FI FIVFF ll'I.«\I-‘Fl’-‘FE m-II‘_-
`r»II‘Iw
`"IIZILJR IDEAL CIIDIEC FCIF-2 LUMIIIII UF3
`I_’>INIIEH...S:.LI LIH~_ FLILIL: EH;-.L.
`Q
`HASI:
`II-.1 THF I
`II-‘F AND I—’LJI,l,
`|_II_‘
`/\ STIZIIZIL.
`
`I
`
`_
`,
`_
`. DRIHI-1. AND. AEII_I\.~‘E ALL. BE 1:-/—.I_TV'.
`
`PORT & STARBOARD (SIDES
`ENSENADA CABBAGE SLAW
`1.99
`GRILLED VEGETABLES
`2.99
`5HAI::I< FRIES (SINSLE SERVING)
`1.49
`GRILLED WHDLE CIDRN
`1.99
`SALAD (HI:IuSE DR DAESAR)
`2.99
`TRI:II=II:AL FRIED RIDE
`2.99
`
`'
`
`KEY LIME BAR
`DRUNKEN SAILOR
`
`TREATS
`$4.99 EAI::I-I
`THE HDT BLDNDE
`SPLIT IN A CUP
`
`NII::ARASLIA
`THESuRFSANcTuAI?.
`A —
`~.
`9-A———
`-
`
`SALTLIFI-:FI:IIjDSHAI3I<.c:I:IM
`
`

`
`FEE RECORD SHEET
`
`Serial Number:
`
`77798851
`
`RAM Sale Number: 3571
`
`Total Fees:
`
`$100
`
`RAM Accounting Date: 20100407
`
`Transaction
`
`Transaction
`Date
`
`Fee per
`Class
`
`Total
`Number
`of Classes @
`
`Statement of Use (SOU)
`
`20100406
`
`$100
`
`$100
`
`Transaction Date:
`
`20100406