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<br />NAMff RITLE PRINCIPAL Q[CVTIV! OFFICER I
<br />E[mlFr UNDER PENIILTV or
<br />LAw THAT I NAVE PERSONALLr ExAMINED
<br />AND AM rAMILIAM WITH THE MFORMATION SUBMITT ~
<br />/7 ~ 1 TELEPNONE D A T E
<br /> ED N[REIN AND BAS[D
<br />ON MY INOl11gY OF TNOSE IMOVIWKS IIWEdATELY IfES{pr51BLE fCq ~ / /
<br />,
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<br />OTAINING THE INFORMATON I BELIEVE THE SUBMITT[O INFORMATION
<br />IS TRITE ACCURATE AND COM{LETE I AM AWARE TNAT THERE AR SIG
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<br />970•SL444Di
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<br /> NIFICANT Pf NALTIES FOR SUMITTINO FALS[ INFORMATION INCLUpNG "-'...L~+
<br /> TH[ OOS51&LITr OF FINE AND IMPRISONM[nT SEE IB USC 6 1001 ANO
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<br />ENT AND E%PLANATION OF ANY VIOLATIONS IRrlrrrnrr all Rllu[hmrnla hrrr)
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