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<br />/61 ;';,rn;/sl
<br />Uvr f~JuvT TU , ~ OMB No. 2040-0004
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<br />roved expires OS-31-98
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<br />IJ3l I7475i 176-771 l26-791 !30.311 NOTE: Raed hnlructitNU bslore oompletinp this form. "
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I NAVE PERSO
<br />MILIAR WITH THE INFORMATION SUBMITTED H NALLY ExAMINED AND
<br />EREIN; AND BASED ON
<br />- TELEPHONE DATE
<br /> MV INQUIRY OF THOSF. INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNINO THE INFORMATION, !'BELIEVE THE SUBMITTED INFORMATON IS
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<br />Richard Mills RU
<br />, ACCUMTE AND COM0.ETE. I AM AWME THA
<br />THERE ME
<br />SIGNIFICANT PENALTES FOR~SUBMITTNG FALSE INFORMATON
<br />INCLUDING /
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<br />Fn I n mnn I M ~ e .
<br />THE POSSIBILITY OF RNE NiO IMPIIISONMENT. SEE 18 U.S.C. f 1001 AND 33 SIGNATURE OF PRINCIPAL EXECUTNE
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<br />TYPED OR PRINTED ,vM or martmvnimpnsmwnt of EarrwF•nemavitlr, •rMbyFnl OFFICER Ofl AUTHORIZED AGENT CODE N ~' YEAR MU D
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e// uttechments here) '
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