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Wthe following statement applies,adopt the statement by marking the hoc and include an attachment) <br /> ❑This document contains the true name and mailing address of one or more additional individuals causing the <br /> document to be delivered for filing. <br /> Disclaimer: <br /> This formicover sheet,and any related instructions,are not intended to provide legal,business or tax advice,and are <br /> fumished without representation or warranty.While this fomt/cover sheet is believed to satisfy minimum legal <br /> requirements as of its revision date,compliance with applicable law,as the same may be amended from time to <br /> time,remains the responsibility of the user of this form/cover sheet.Questions should be addressed to the user's <br /> legal,business or tax advisor(s). <br /> AMD_PC Page 2 of2 Rev.12/2012016 <br />