Laserfiche WebLink
<br />PRINCIPAL EXECUTIVE OFFICER .. <br />I CERTIFY UNDER PENALTY OF L <br />AM FAMI <br />IM WITH THE INFO <br />AW THAT I HAVE PEASO <br />RMATION SUBMITTED H <br />MALLY E%AMI <br />AND BA <br />EREIN <br />NED MD <br />RED ON <br />TELEPHONE <br />DATI: <br />. : <br />L <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIB LE FOR ` <br /> OBTAINING THE INFOIUMATION, 1 BELIEVE THE SUBMITTED INFORMA TION IS <br /> TRUE. ACCURATE' MD COMPLETE. I AM AWME THAT THE <br />SIGNIFlCMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />IN RE ME <br />CLUDING <br /> , <br />THE POSSIBILITY OF RME MD IMPRISONMENT. SEE to U.S.C. f 1001 MD ]] 610NATL111E OF PA CIPAI EXECUTIVE <br /> v.s.c. f I]IS. /n,.m.....w sl.r mrvM, err NrA.W rw. w ro sro,000 <br />C <br />E NUMBER YEAR MO DAY <br />TYPED OR PRINTED .nl ar mrrinun hmrlswn.Nwe.n...n 6marW rd 6YFra/ OFFICER ORA ORIZED AGENT OD . <br />1ND EXPLANATION OF ANY VIOLATIONS (Re/erence el/sftschmsnts here! ` <br /> <br />0.1 108-95) Previous editiom may be'used.. (REPLACER EPq FORM T40 WH~CN MAY NOT BE USED.) ~ PAGE OF <br />. ODQ33~146p9 14-4 1 <br /> <br />