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r <br /> Rev 2/23/2001 <br /> Page 6 o£6 <br /> Preparer represents that to the best of the Preparer'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 /> t suppressed or misstated <br /> User's Signature Date <br /> Preparer's Signature Date <br /> Respondant's Signature Date <br /> 4 � <br /> i � <br /> • <br /> Q WormsTield FormslESAlTransacuon Screen Questionaae doc <br /> Initials h� <br />