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'J 0 '::a'PER.ML~ - <br />~.:: <br />,..:..,e <br />_ : <br />... ?Y*/yF.It'6'::. .: <br />`:.. iiert~iiT 7 - <br />~ i 4~#4#x t<+ty.4tt4-'t ,;. s. ;.~r•rti ti <br />... <br />+•. <br />E~tiT_Y <br />[ SU«L <br />hr LvL•;rT br!ti55 VALJ . <br />.. <br />~¢41AEhiENY` ;~;;>.,..;:`."'.<.;.•.....: ..-11d'~T:-lfli:>i.:i. ,/ J r.q;.~. . <br />- . <br />NAME?/TIE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFr UNDT,11 PENALTY OF <br />AM FAMILIM WITH THE INFO lA1W THAT I HAVE PERSONALLY E%AMINED MD <br />RMA710N aUEMITTEO HEREIN; MO BASED"ON TELEPHONE DATE <br />-~~' ~` r ~ <br />h ~- . I j- !-i ~ I,1 , r C. /~f~~ <br />!!!!!! !! MY INQUIRY OF THOSE INDIVIOUALa IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING TH6 INFDIU/ATION, (BELIEVE THE SUBMITTED INFORMATON IS <br />C <br />T <br />D COM <br />E <br />W <br />/ <br />- <br />~ TRUE, AC <br />UM <br />E M <br />TE. I AM A <br />ME THAT THERE MF <br />R <br />SIGNIFICMT' PENAlTlE9 FOR SUBMITTING FAIaE INFORMATION <br />INCLUDING I ) _ _ <br />- - ' ~ . <br />~ _ <br /> <br />I <br />{-' <br />_ .-- {'- <br />.- <br />' , <br />THE P059GIlITr OF HNE.MD IMPPoSONMENT. aEE le U.S.C. F 7001 MD 93 _ <br />~" <br />1 <br />~ <br />~ <br />~ <br />, L <br />,~ <br />I . f i3t a <br />/A <br />ri <br />w d <br />hd <br />x0 <br />000 <br />U: <br />d <br />g SIGNATURE OF PRINCIPAL EXECUTNE _ , <br /> . <br />r/r <br />• u <br />.,. mnm• mry <br />rr <br />, <br />S.c. <br />a <br />+rA w ro t <br />TYPED OR PAINTED rw ar rrlui/IVn t`/rMswrrnrwMrlrrn smmMaW6{oral OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />LUMMCIY 1 J N1YU CAr LMryM 11V 1Y Vr /r1Y. Y IVL/r I1VIY •l l/I tl/tlI0/IGI tl// s/uG/ngap(i /IY/tl/ <br />T~, J Tul.>.L IF.UI+ Llr"lIy :rll,l DL ++AiYL~r A;rL ~LTfLLA~Lt ,,-,LIJ;; _l fi'i '.Tr -/ -, 1.? r_-. r .-l;;r• _V .1- <br />.~LL Y.L r.u Llr tJf 1'1\Liur IiL aI L/iKI:.7CNT~ l/VJLrt T.rS. ja !~• G• l.iL .. ,: F.C.. Jf~ ~ •_- . •... ... ~ -, r'_ ',r_ 1~ <br />' l- - - <br />PA Form 3320• 108.5 - Prsgoua a inpm mgY~be we ~ CES O -4 ICH MAY NOT BE USED./ PAGE OF <br /> <br />