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1 . <br />(I/We) do hereby swear under penalty of perjury that the <br />foregoing statements are true and correct. <br />Date Applicant <br />SUBSCRIBED AI`ID SWORN to before me this day of <br />(Notarry Seal) <br />Notary. Public in and for tke . <br />State of <br />My Commission Expires: <br />4 <br />