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I certify under penalty of perjury that I am (check one): <br />LpLegal owner(s) (All owners must sign as their names appear on the <br />deed.), <br />Q Corporate officer(s) empowered to sign for the corporation, <br />I ---I Owner's legal agent having Power of Attorney for this action (a <br />notarized Power of Attorney document must accompany the <br />application), <br />and that the/in is and correct. <br />q <br />(Signature) <br />(Date) <br />(Signature') (Date) <br />(Signature) <br />(Signature) <br />(Date) <br />Date <br />C <br />Major Subdivision - 9 - (7/84) <br />