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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER. 1 CERTIFY UNDER PENALTY OF LAW TNAT I HAVE P ERSONALLY E%AMiNEO ''
<br />~
<br />- ti . _ TELEPHONE DATE
<br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTE D HEREIN; AND BASED _
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<br /> ON MY Iry0U1RY OF THOSE INDIVIDUALS IMMEDIATELY RESP ~' :)
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<br />Brian P, Dunfee is '_ ONSIBLE FOR
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<br />ELIEVE THE SUBMITTED INFORMATION G
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<br />9 IS TRUE, ACCURATE AND COMPLETE. I AM AWARE TNAT THERE ARE 510. - _
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<br />p NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />THE POSSIBILITY OF FINE AND IMPRISONMENT, SEE 16 U.S.C. { 7001 AND T
<br />$IGNATUREOFPRINCIPALEXEC TIVE 02' 774-5253 ~ 91 04 29
<br /> OJ U.S.C. { 1]70. IPrndlb undo (Aar amn.le nMy Inrlude foe yp'lo J/O,OR) 1
<br />• TYPED OR PRINTED
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<br />• - ~ :II 00029/1005H9-17+14 1 2
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