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SERVICE PROVIDER:Please fill in the spaces and sign in the box appropriate for your business <br /> entity. <br /> Corporation <br /> Full Legal Name <br /> r 4-retiq 15--rt-;4-1,1b -1-0/60/61,,irt - <br /> Signature: .A-- /1/0_C -- <br /> Name of Signer: yt //€t1,L— <br /> Title of Signer: ,ff5/t4e .- <br /> Partnership <br /> Full Legal Name: <br /> Signature: ,Partner <br /> Name of Signer: <br /> Sole Proprietor <br /> Signature: ,Sole Proprietor <br /> Name: <br /> Limited Liability Company <br /> Full Legal Name <br /> Signature: ,Managing Member <br /> Name of Signer: <br /> Page 3 of 3 <br /> Standard Document Approved X.X.t 3/Office of City Attorney <br />