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Disclaimer: <br /> This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, <br /> and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy <br /> minimum legal requirements as of its revision date, compliance with applicable law, as the same may be <br /> amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should <br /> be addressed to the user's legal,business or tax advisor(s). <br /> AUTHORITY Pagc 3 of 3 Rev. 12/01/2011 <br />