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SERVICE PROVIDER: Please fill in the spaces and sign in the box <br /> your business entity. <br /> appropriate for <br /> Corporation <br /> � <br /> Ac+ Cro�e rQ' <br /> ��� -�'f^ <br /> [Service Provider's Com ete Leg Name) t'��lf'Ct� <br /> B <br /> TYp /Printed Nam F_ <br /> Date: \ A.G ' <br /> Partnership <br /> (general) <br /> [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 /> .._.._---._....-- <br /> Managing Member <br /> Date: <br /> Page 11 <br /> Hart Crowser PSA 2021 <br />