|
-- --- c.CliYrr--.. .(;'ii'j , � , � . . .... . ,^ , . " •}� F�`�(!�•(��,
<br />• 1�����Y��:�l.� ,,JJ • , �.�[_1\{Y������ . . i ' \'6rl'.. • /��'`'1
<br />• , ' � ., ',� .. . t
<br />' . ' ' , . .' . ' : ' . . .,.�....+;�.
<br />rltv� uni � r.r+:uaa . . . . . , , .
<br />• �v��u�i,wn �m�n� COf11t:IN/1,'fIOPJ • DUILUIPJG ' • .MI:CIIl1tJICl1L��• I'LUMISIfJ� • ��;;.�;Y
<br />' uwn� n . . � �nnit nuuiu.:.�. ,. nr. riwn�. . ' • '
<br />I....•%�.'.1..�`ff1_�i�,�.__��_..._::.,�viS.:...�f> �'��.d_:... . . .��5_�_ yUv � .
<br />niu �n i ci un i,�:.ior�u� . mni� noiii��i,� "" �'". r�wr�e` , . ucer+::� � �y � �
<br />..
<br />� . �' ' CG /0 �,S�LCJ . '�SS-:_JG;�'7 ,� �a•�-
<br />�.;.. �.1� � �v ' _�..----._.._. .%:'----.___.�.__..--�-- 1�C'r._�:• �rv�/3z
<br />4LNl IAL CUI.�1 � 611 MAII. AUUlll.f.i Pllbl![: UCE N:�l. NI
<br />� . . •
<br />( ��.� �iAll�.�l•L1OIIlSG'+ ��..�—YIIONL IICEM.:L NC '
<br />C. L - .1.' {�,��F L� .
<br />—�� MAILAUDIIhS:i—/� , 1'/1UNE UCCtl.1�.N0
<br />L .rn� • S/h c7/n �
<br />❑coraniNntioH ,
<br />�UULLOII�G []�P�UAtI11hG [�IA@CNANI�qL '
<br />'_'__ ' --- QNE1V' - _ _ ❑4DU1��0.� ❑ALICIIATIbN �VMII
<br />R�S7
<br />p�urA�31NG
<br />❑UCIdULISH ❑fCNCF: ❑SIGtJ ❑GY�I1.I�AING P60L
<br />)) <r
<br />,r a.• .. �< — .
<br />iu�T1UN OF VIlOPGftI'1' ISMOY! 6L�G\71iR AT1 ACN
<br />a�.ocK�r �� � I'('�i nl H l'
<br />��:
<br />,
<br />TER $E�tVICF 517.[
<br />)@ YAl1U 561 UACK
<br />`�T� T �r
<br />— Z—
<br />ti�EC1A ONUIlIONS:
<br />U r Y n
<br />fll.OG.SUt�PLY $17[�{/
<br />iAC1: fiLAflY�17/U$'�
<br />i �-Vr-j
<br />Vl�CANI 517 C
<br />(]YCS �1G0
<br />GFtOUI' NO. UF U�YhLLING
<br />IUN17ti
<br />0
<br />r,�ecffaraicn�
<br />TYPC OP CN[NGV -
<br />C] C !.5
<br />NO.! TVPG.OF F.CUIPMCtJT
<br />--ln7ii coraci. uurts-i�.r. en. ' -
<br />..---i...__... .. .- -•�- - --
<br />rtt I'P0.'.t�rv.i �n:i �Urii(���ii'r. CA.
<br />_-,._�......_.....' _.' "'..__._....._..'_._.
<br />f:O�lf.r:';���Lr. F.n.
<br />� IfU17CfUAlI15Y�TEf.ti" ' "
<br />II.1.V. Mi.
<br />._ _� "_"'_' __—_""__
<br />� �
<br />��ll�/il �..
<br />, ,�-�..�.,.,
<br />e�_
<br />@LF.C.
<br />S _,.' ''_
<br />'___i_'
<br />'---�—'_
<br />1
<br />S�AC[ t. NlLL II�Aif.fl; - p.LV, � �
<br />�- UNiTI�EnTCR: II.T.V. j �
<br />�IfVA�l�ItA71VECO(11Cf::___---"-- _ ---r' _
<br />� . - -- --- -
<br />CLOl11i::.f:livl115 �—.�_ �I U G
<br />vcr;t��niio.v rnni �—
<br />-- -- ' - ... - . .'---- ----�—
<br />anui:r_nunt> - i
<br />--��;��,;:,::,;;,:,��,,.�T--- �.�.,.;--=f=--,--
<br />---.-�---.....--- ------ - ,`
<br />,
<br />" wnii�i���ienT[n....----�--...--- --7—
<br />.` _ ..._..-- - . .__._..--_..-'-------- �—
<br />�nc. �wii.r nn�.r�nc[ r, a�ie.+uEr �
<br />"'- Gn;:�$v57[bt: NO Or Oililrr5��_-'-' '—�—
<br />._". _'. _ . _..""_'_"" " ".. _.." "" "' _ .._ _
<br />---- --- - ---- sunlo�ni_s7,__ 3 i0-/S
<br />. • �F H\t1i GT �T—s
<br />{
<br />iorni 7i c � 3c.� �
<br />_J �_ __.__ �
<br />�IIIi:i FCIt:'IT Uf�COfdl.i fCVI L lu�:l1 VOII) If \\•Ortti (�f��Ol:$iCllC-
<br />TIqN AVtI�UIi�ZCO I$ NC�T CC:VaEItiC4D P;1T111Y 170 pAYS, Of11F
<br />C�l:,^.Tf:JCi lOfv ft(i YlQPI� 1 i iU$P4t:pCl1 011 ACA?.P10::f f) : Ufl A
<br />Pf NiUD U1� I?d pAYS AT AM\' 11.'uC Af 7 Cfi 17071�; I$ CUt.:\lCf<CEO.
<br />I HFR[ItV q[RTIfY THAT 11!nV[ REAI] 4::U C%A\'IVCD 1111ti AP.
<br />�LIC4T1:1\ At.D KNO:V T11f Snr.1C Try L'f TFV6 11�.0 CC�IU�i.CT. ALL
<br />PflpVq;�pP:!: pF LALY$ AND f�1�p�hAfVf.C:: GOVFH::t::!i 1H1$ TY{'G
<br />Of YMfll: C:tl� fGCO\t1`ItCDYlI�MYiHSti!r�tSPPCIfIEDrlCttlilN
<br />qR NUI. 1�11! (1!(l.r:1�L'. l�P A V[I1Vii Itill.^. Npl �'RC!:V'.�F TP
<br />GIVI l�I/71�•JfiITY TO VIOL41E Oi: Cl.t:(7F.1 IHl f'LUY�71Uh`: OF
<br />nNY' 011lE.'t �7ATC Oft LUC�\L IAtY {:I'.Ul ATlf�t} CON5111UC710N
<br />O11 THC PCflf OfIMAKCk UF CON51'I:S1C11UN �
<br />.`IpCylµy(lfilipiCON111I�ClUIlU11AVT11./�GLNL pAIL'/
<br />_,�
<br />i'L.1N C111 U; NVfdUh❑ FLAN CIIICK f FC
<br />FCE � �RCCCIPT NO.
<br />1'IOM � FCfi
<br />IAn%.UCC.l04U I1lI1LOWG S�j�;E%Lj - �
<br />, ��-o I C.' C.>
<br />—_ _1_
<br />_ ri.ur.�nirv, . � t� � Cl_�L_
<br />��iiii-vi�nu;T:i t.ns
<br />IIlOU1NEb
<br />L�YEG I_INO Atl'CIIANICAL— ' .�;C �
<br />OTHI'll • �
<br />Pf.NALTV 'LC.�OJ(+1 I
<br />.. __ 1
<br />TUl'AL �
<br />L�_ C I e L%
<br />1'1'.IIA111 VAI.IIiAIIUN ' •
<br />1V111 N PIIUPI IIL V VA1 IIIAf 1 O IIN l lll ::11'/�C(1 T111:: IS Y011fl l`CYIAIIT
<br />�
<br />%JPIII.Ah�111qJIR11�11• Inh'.1i41�11111� y~�� �II'��PVIIIItl111':A�.1y�111I
<br />._ ..__.._._...1___________..__..._I ._r__.._._ . n
<br />„„�,�,�,., ,,,,
<br />
|