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ci��v or �v�iiL.r,r <br /> PUI3LIC llISCLOSURE RGQUGS'1' POR INFOIi�IA'Ct0\' <br /> Phunc: (a�j) 2i7-RLIO P:�x: (a2i)2i7-R7a1 2930 \�'cunurc:��'c., Gc.rc�t.«'A 98?Ol <br /> S./? /h'�'/��{��' /or cucl.e rr/�i�upl'in��� ITiIl�' -1_' K.C�. I1�.1 <br /> Rcqucs�or's , <br /> i <br /> Printcd Namc: .Jc,S/� � �//c,�/ _ and �,r <br /> I3usincssNamc: C� '/'vc.� Co.,-Fr c¢ � anJ Conrh-4o++J., -L•.c <br /> Sienaturc: ���-- - - -- <br /> r�ddress: ��,� ��G2S 4-n-�� h�/ S`rc c-mail: G e�lcc-,�c_�v�r_��,,.��i _ <br /> �v�re� l./r9 �j9?cv - - <br /> Phonc No.: Y2�S�B'/Z�- A'afe: ff your phonc h.i� .� hlock on it �cc c_mr.u� runtuct ��uu. <br /> Plcasc contact us aftcr ��'c busincss dac;. <br /> Allu��� mc tu: k inspccl ---rcqucst a copy of thc Ibllo�ving rccords Plcasc bc specific. <br /> r'f�� G yryt„I- p�o..f Ge�.��um �3 'Fo 7 /�7 La r� � _ <br /> �� <br /> If rccnrd(s) conccrn individual(s) ot6cr than rcqucsror. Plcnsc statc. <br /> Is':u�c the iequcstr�l iacord(s) to be uscd lor n commercial pwposc'? _ti'es X No <br /> �N Icl�lC� -- <br /> �� �:� <br /> � i _, ��( <br /> ,1, . <br /> � <br />