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SERVICE PROVIDER: Please fill in the spaces and sign in the box appropriate for <br />your business entity. <br />Corporation <br />i <br />[Service <br />By: <br />P vider's <br />Complete <br />a <br />tot <br />- _ t4A <br />Legal <br />Name] <br />Name: <br />„. <br />t cL4rk <br />Typed/Printed <br />Its: <br />Date: <br />Partnership <br />(general) <br />[Service <br />a <br />By: <br />Typed/Printed <br />General <br />Date: <br />Washington <br />Provider's <br />Complete <br />general <br />partnership <br />Legal <br />Name] <br />Partner <br />Name: <br />Partnership <br />(limited) <br />[Service <br />a <br />By: <br />Washington <br />Provider's <br />Complete <br />limited <br />partnership <br />Legal <br />Name] <br />Partner <br />Name: <br />Typed/Printed <br />General <br />Date: <br />Sole <br />Proprietorship <br />Name: <br />Typed/Printed <br />Sole <br />Date: <br />Proprietor: <br />Limited <br />Liability <br />Companya <br />[Service <br />By: <br />Typed/Printed <br />Managing <br />Date: <br />Washington <br />Provider's <br />Complete <br />limited <br />liability <br />Legal <br />company <br />Name] <br />Member <br />Name: <br />Page 1 I <br />(Form Approved by City Attorney's Office January 7, 2010, updated November 4, 2020) <br />