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p�����5� D naa«ss: 5���,� v� _ <br />IN FllLL - � - <br />Tule. -i�r�� 1 �i�i.�tG� <br />TelephoneNo.:�(�) 3S$—/S�4 <br />�6.�,1.z , �o;G <br />•••••••••• � Contact Person: <br />ci�v o ERE7T <br />('ublic Works Dept. <br />1. For an acknowledgement in an individual cnpacity: <br />STATE OP WASIiINGTON, <br />)ss <br />COUNTY O� SNOH01�11SH <br />1 certify thal I kno��� or ha�•e salisfacton ecidence that �a.Q `�/�/-/%,_ 1-�QHIytOL� <br />signed this insirument vid ackno���ledged it lo be (his. her. their) free :tnd � olwitv� act for the <br />uses mid pur��oses mentioned in the instniment <br />��,_ P,. .,r _,� <br />�. , •p1A1A.�EA.'p, , <br />' �pTAqy '. <br />,t : �. � : rt <br />, N� �cfp�BLl� oo^;�,� <br />"^'9l �eEq2'I �G��,. <br />�J�`"��.�F WASN�..�'`�� <br />(Seal or Stamp) <br />Da�cd: 3 / 200 — <br />Signature of N ry Pubhc <br />Notan� (print name) ��v� _ <br />Residing al: ��t y�,Q_�� <br />�1� commissions espires: ��O%X� L7i LOv�-- <br />Assi�, �ment of [unds, Pa .. of 3, <br />