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L00 toed 0 dicleioos 0p0JOl03 .41 <br />01e8i'89e0e -tnoJd 0 + 0 11 1 80 4002- 10 -noN panitotb <br />This perjury notice applies to caoh individual who causes this document to be delivered to the secretary of <br />suite, whether event mach individual is named in the document as one who has caused it to be delivered. <br />I I. Name(s) and address(es) of the <br />individual(s) causing the document <br />to be delivered for Ming: Kce= Jeffrey H. <br />7400 E. Daley Av Suite 900 {Faroe) Middle) (Suffix) <br />Over name and number or PAST ice Vox (rllnnmanun) <br />Englewood Cu. 00111 <br />POO (,are) (PorielMi, Cede) <br />(PPovbu - +tfopnlirahla) (Gauntry— (pun 'IV <br />(Ihc doeu near need nor caws the true name and addrers afuwre !Batt Anw, vvr, ifyne with m atms rhu mmilv and ndrbpse <br />ofony additional indisdduals stains the document to be dclirared for ins mark zM, boxDand intfudo an anaelnzwnattains the,nw <br />antis Vouch a:dm:duds %) <br />Disclaimer: <br />This form, and any related instructions, are not intended to provide legal, business or tax advice, and aro <br />Offered as apublic service wlthoutrepresenta±ion or warranty. While this form is helieved to satisfy minimum <br />logel requirements as of its revision date, cr utplianue with applicable: law, as the same may be amended from <br />time to time, remains the responsibility of the user of this four. Questions should be addressed to the ueer'c <br />attorney. <br />Rev. 7/13/2004 <br />4 ad <br />Loo©1 Z a d1 OLC6V69C0C XV1 So:SO voOZ /TOftT <br />