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Rev 2/23/2001 <br /> Pare G of 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 Pieparer's actual knowledge no material facts have been <br /> suppressed or misstated <br /> r � <br /> User's Signature Date <br /> Preparer's Signature Date <br /> Respondant's Signature Date <br /> h <br /> x, <br /> I <br /> f <br /> i <br /> U TonnsWield Fonns%ESMTransaction Screen Questionaire doc <br /> s ; <br /> Initials <br />