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R V C �� PROVI i o Please fill in the spaces and sign in the box appropriate for <br />your business entity. <br />Coiporadlo <br />[SeI OTTPX try , <br />tvjce Provider's oznplefe LegallName <br />B , - � rl '�k'�it <br />y• (it ra�r�S )'Jic7 <br />t74tvjx,eHo <br />Typed/Pri ted dame: ' / • ST <br />Its: �flwG i�r<}l, <br />Date: <br />Pal*gen'hip <br />(general) <br />'artneir shtip <br />(1/;; z h ed) <br />[Service Provider's Complete Legal Name] <br />a Washington general partnership <br />By: <br />Typed/Printed Name: <br />General Partner <br />Date: <br />[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 <br />Company <br />[Service Provider's Complete Legal Name] <br />a Washington limited liability company <br />By: <br />Typed/Printed Name: <br />Managing Member <br />Date: <br />Page 11 <br />(Form Approved by City Attorney's Office January 7, 2010, updated August 16, 2019) <br />