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Rev 2/23/200I <br /> Page G of G <br /> Prepaier represents that to the best of the Pieparer's knowledge the above statements and facts are <br /> true and correct and to the best of the Preparer s actual knowledge no material facts have been <br /> suppressed or misstated <br /> User's Signature Date <br /> Preparer's Signature Date r` <br /> Respondant's Signature Date <br /> t <br /> lie <br /> s <br /> i <br /> �I <br /> i <br /> b � - <br /> O Torms\Field Fornu\ESAlTmnsactton Screen Questionnire doc J� <br /> r <br /> Initials <br />