1150IFA 1I-AWI1m1,,,)I GAIMBILING 6/1-1"n u!warn a,lof 2
<br /> E.G23A PieIrIrvfit atlo °' lIv a Fee °' 5 ' �IllliF E
<br /> ............ ... ...........w...w .w .................,....... ... ...........................w.........w........................ ..................,....,................. ..............
<br /> UIII'II D TTA' � 1LG214
<br /> ,, If the irel'TplSieM IS leased, l a colipy.oF.. y . w.�; GN B^ III i Mall ItIlille apiplilica,11I aind lr gunire ttachiIi-inVWkdlll"mts.t
<br /> iii ease for I,,,,awriaii III'IIPIiiblllNlll'fll ivIII ' P'4I 11 neso Gaii'11"III::OiiII"BI ',VII°ptlrol INS(.:o'd
<br /> .gip '$1.510 Pnln inuua'll Ig:)u IMIises IG;aelrm°nalit
<br /> I ' fee, fau,,, ln:9pg:aenu,amt(irrl lril.re-*f.uw!sldaI„rll ) , des Cbu.wlrt
<br /> Ioald 13, St� 010 ,ouith
<br /> IS l � ;bR:,a� �l�l � as� of lll��iimnute„ RI sr ill ryII*I4 551 .
<br /> I iiinins (:,alill 651....539.:R.' 00 aind aaMir„Rau,,,IN,,,iic: lrnsiinll'g.
<br /> ORGANIZATION F
<br /> arn�nu.. A�n m r
<br /> n
<br /> anV"' a':0111a NrCBr; inse Tln a
<br /> I' u
<br /> CRanerN' Execubve u? Naanry °CEC:'w ,,— �" � .... .... .... .... .. ....
<br /> m am„po *siilliea. X81 uSi
<br /> mbfia'n anu'urrer: .. ” VI ... � a am ^, .,,�ii an' '�RI� ViaV� . u' i
<br /> w y F��nr'anna' a�
<br /> AMBI 1NG
<br /> I °
<br /> 1Nl1111'Rm II�IOR1111
<br /> Led:t nIIIIVummm f NnaNn �a „ aNrNN aa �unaun
<br /> mp1 V I°
<br /> ........
<br /> ..
<br /> M...Rst any pra:Mou s names ffi,"nlr thIii» 11oca,,aticil a,
<br /> � 01111� Ao
<br /> la
<br /> (Mr not use .0,box number m rwazn&w n address,)
<br /> City, OR
<br /> ..N'"anranwu15NnNCa u"rnruun ,nn Zwp CwmN :
<br /> l�" 'au Cd
<br /> ., n
<br /> Does yaw aarzatrananar the buMngarunthe uaw°a°mblN g dNNbe,conducted?Oyes j111,1E4No If
<br /> no, attach N_GI12.1aaaase fur II awtul CCau°anRaH nn ActivRy.
<br /> ff
<br /> ullni:�n., iCNu �t�w�e�Nnaadaa� oraffle
<br /> l9uara �aran� uu� will
<br /> °n �acrp CN� amwCa;'N Yes au
<br /> 1 l
<br /> g at
<br /> �n
<br /> u'Cr: Bai bingoucan anN be uaaa' u °N
<br /> at s site where another funn of f dM guo° l m being ocniducted iq °w
<br /> a ppNyN orgio R-
<br /> z tlionor anoLher erafted wnftaCwoaN � Crura auauuaa aaC�condUcted at s an where paper Cu.nNN_U.ilNs we CnNuayen.N.
<br /> Has YCKWorga0zabon previouscon`ndtjcNa:naN g w°nntifirnn at th° site? )''Woad Adm c)nn"`C know
<br /> SII VIII.' '' llMIA �K,�A �m'C ����IIIIIN � �F '�KO '; IIIIP „ �IIIII� '� 1°i ��I �, A
<br /> k Ca rn°n ° ... 8annk 'w"rvw.wrnC Nunaanbei: ...
<br /> Bank Strelarvt Adclires a' (AY. State. 11114N Dp n�Ae.,
<br /> ALI 1111"EMPGRARY AND PRIMAIVENT OFF-SM STO RAGEOFF-SSPACES
<br /> uaa dr' ^ss (r)un not use ad P.0, boa ..
<br /> rnaNun ' Cit Rat dpnriln.
<br /> MN
<br /> IINIIY'�
<br /> 30
<br />
|