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J <br /> SERVICE PROVIDER: Please fill in the spaces and sign in the box appropriate for <br /> your business entity. <br /> Corporation VI 7 j, L f7 S <br /> [Service Provider's Complete Legal Name] <br /> By: �� 1 <br /> Typed/Printed Name: klUts J DA-v►'y <br /> Its: ?—toLt L.z P,A-1-- <br /> Date: 41 2 7/c7 1 <br /> Partnership <br /> (general) [Service Provider's Complete Legal Name] <br /> a Washington general partnership <br /> By: <br /> Typed/Printed Name: <br /> General Partner <br /> Date: <br /> Partnership <br /> (limited) [Service Provider's Complete Legal Name] <br /> a Washington limited partnership <br /> By: <br /> Typed/Printed Name: <br /> General Partner <br /> Date: <br /> Sole <br /> Proprietorship Typed/Printed Name: <br /> Sole Proprietor: <br /> Date: <br /> Limited <br /> Liability [Service Provider's Complete Legal Name] <br /> Company a Washington limited liability company <br /> By: <br /> Typed/Printed Name: <br /> Managing Member <br /> Date: <br /> Page 10 <br /> (Form Approved by City Attorney's Office January 7,2010, updated June 7, 2012) <br /> 13 <br />