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SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Owner (s ) (All owners must sign as their names appear on the <br /> deed. ) , <br /> corporate Officer (s ) empowered to sign for the corporation, <br /> Owner ' s legal agent having Power of Attorney for this action (a <br /> notarized Power of Attorney document must accompany the <br /> application ) , <br /> and ttTt the foregoing is true and correct . <br /> — (619nature ) te ) <br /> LA��� i3 - _ , /1/ ✓ /l 1 <br /> (Signature ) ( bate ) <br /> (Signature ) (Date ) <br /> (Signature ) (Date ) <br /> Minor Subdivision - 7 - ( 7/84 ) <br />