{"entity":{"id":8273910,"state":"FL","state_id":"292013","entity_name":"FORT WALTON CONCRETE SUPPLY, INC.","entity_type":"DOMP","entity_type_normalized":"domestic_profit","status":"I","filing_date":"04161965","filing_year":1965,"business_age_years":61,"principal_address1":"P O BOX 655","principal_address2":"26 INDUSTRIAL AVE.","principal_city":"FORT WALTON BEACH FLA","principal_state":"","principal_zip":"32548","principal_country":"","mail_address1":"P O BOX 655","mail_address2":"26 INDUSTRIAL AVE.","mail_city":"FORT WALTON BEACH FLA","mail_state":"","mail_zip":"32548","mail_country":"","location_name":null,"location_address1":null,"location_address2":null,"location_city":null,"location_state":null,"location_zip":null,"fei_ein":"591091014","jurisdiction":null,"county":null,"last_transaction_date":"12111976","report_year_1":"1975","report_date_1":"10031975","report_year_2":"1975","report_date_2":"10031975","report_year_3":"","report_date_3":"","agent_name":"Raymond Curtis Chavis","agent_type":"C","agent_address":"289 BRIARWOOD CIR","agent_city":"FT WALTON BEACH","agent_state":"FL","agent_zip":"","process_name":null,"process_address1":null,"process_address2":null,"process_city":null,"process_state":null,"process_zip":null,"source_file":"cordata3.txt","fetched_at":"2026-05-09 10:48:19","updated_at":"2026-05-09 10:48:19","last_accessed":null,"status_reason":null,"agent_name_raw":"CHAVIS,RAYMOND CURTIS"},"officers":[{"name":"Carol A. Chavis","first_name":"Carol","last_name":"Chavis","title":"Secretary, Director","title_roles":["Secretary","Director"],"title_code":"sd","is_registered_agent":false,"address":"289 BRAIRWOOD DR.","city":"FT WALTON BEACH","state":"FL","zip":"","name_raw":"CHAVIS,CAROL A."},{"name":"Eva M. Chavis","first_name":"Eva","last_name":"Chavis","title":"Vice President, Director","title_roles":["Vice President","Director"],"title_code":"vd","is_registered_agent":false,"address":"864 TANGIEWOOD DR.","city":"PENSACOLA","state":"FL","zip":"","name_raw":"CHAVIS,EVA M."},{"name":"Raymond Curtis Chavis","first_name":"Raymond","last_name":"Chavis","title":"President, Director","title_roles":["President","Director"],"title_code":"pd","is_registered_agent":true,"address":"289 BRAIRWOOD DR.","city":"FT WALTON BEACH","state":"FL","zip":"","name_raw":"CHAVIS,RAYMOND CURTIS"}],"filing_history":[],"status_history":[],"unknown":["status_history: we do not collect status-change histories from the source feeds, so this empty list means we hold none — NOT that this company's status has never changed. Observed changes we DID see are under `history`."],"verified_domains":[],"history":null,"web_contact":null,"provenance_url":"https://private.rootz.global/api/provenance/FL/292013"}