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SERVICE PROVIDER: Please fill in the spaces and sign in the box appropriate for <br />your business entity. <br />Corporation <br />[Service Provider's Complete Legal Name] <br />By: <br />Typed/Prnited Name: <br />Its: <br />Date: <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) <br />[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 <br />Typed/Printed Name: <br />Sole Proprietor: <br />Date: <br />Limited <br />Fitch & Associates <br />Liability <br />[Service Provider's Comple Lega Name] <br />Company <br />a Delaware limited liabilit omp y <br />By: <br />Typed/Prir} e a e: Joseph J. itch <br />Managing ember <br />Date: Sep ember 2, 2014 <br />Page 11 <br />, h ZQ1 : SA <br />74 <br />