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SIGNATURE <br />07 <br />Q <br />LI <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 )f9galagent having Power of Attorney for this action (a <br />notariz Powe of Attorney document must accompany the <br />applic o,)), <br />an4 t)At/*e/fq/regoing is true and correct. <br />(Signature) <br />r <br />( nature) <br />��.-,� <br />' A S1,Jf gttr )-- <br />(Sianature) <br />9{ • 4"I� <br />- IVU <br />(Date <br />(Date) <br />(Date) <br />(Date) <br />Major subdivision - 9 - (7/84) <br />