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D <br /> 4 <br /> Rev 2/23/2001 <br /> Pace G of G <br /> Preparer represents that to the best of the Prepai er's knowledge the above statements and facts are <br /> true and correct and to the best of the Pteparer's actual knowledge no material facts have been <br /> ' suppressed or misstated <br /> User's Signature Date <br /> I <br /> Preparer's Signature Date <br /> Respondant's Signature Date <br /> t <br /> r <br /> rl <br /> 4 <br /> C <br /> a <br /> e <br /> x <br /> r <br /> U 1FonnslFiekd FormslESAlTransaction Screen Questionaire doe <br /> Initials <br />