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SERVICE PROVIDER:Please fill in the spaces and sign in the box appropriate for your business <br /> entity. <br /> Corporation <br /> Full Legal Name me-5 • 413 o � <br /> Signature: W • <br /> Name of Signer: ak 1 /i'-±4 <br /> Title of Signer: UI Cc <br /> Partnership <br /> Full Legal Name: • <br /> Signature: ,Partner <br /> • <br /> Name of Signer: • <br /> Sole Proprietor <br /> • <br /> Signature: ,Sole Proprietor <br /> Name: <br /> Limited Liability Company <br /> Full Legal Name • . <br /> Signature: ,Managing Member <br /> • <br /> Name of Signer: • <br /> Page 3 of 4 <br /> Standard Document Approved 4.22.14/Office of City Attorney <br />