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SERVICE PROVIDER: Please fill in the spaces and sign in the box appropriate for <br /> your business entity. <br /> Corporation 434sorn+' sriare, untQrftag ,ctsu:,r,a r-tDiv <br /> ll.iv, i- 1 Sr4,-S . d-ct4LrY S o:3r / c c't4-r7o: l <br /> [Service Provider's Complete Legal Name] <br /> By: /O (`iii vt. <br /> Typed/Printed Name: D i; /�C Gl1� t't <br /> Its: Sr t— USW+at✓V e-tti�r <br /> Date: 11-L,- t, <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 Iimited liability company <br /> By: <br /> Typed/Printed Name: <br /> Managing Member <br /> Date: <br /> • <br /> Page 11 <br /> (Form Approved by City Attorney's Office January 7,20I0,updated August 16,2019) <br />