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<br />1- <br /> <br />CERTD'ICATE 01' COMPUANCE <br />DEPARTMENT 01' REVENUE <br /> <br />"--4 tit UI....~ SIatDID 270.'72 T8Il ~:.~.~ '-....~ ~ T......~ die Hl-...... <br />...,......I\r is __.... tit pio6 to t1lo IAll-Ma "Ao~llA""_ at....... yCJIII' 'II&:l.~ <br />.......... T_ "...........'-' N.....IHlr IIIId ... .... ..A. .fl. ......~ at .-II ..... <br />~ 1&................. ~"'III\.. <br /> <br />Um1ar die M...~ 00,-.....-4 DaIa,... Act.... ... Pedcml ,.." Act of 1974. we <br />8IOA4..uct to advJse)'CIII at... fo1lowfas ~.H.. die _ attis ~_.I..d...IIl: <br /> <br />1. '11IIs ~ may be 1IIIId 10"" dto I~~~ RBIIIWIII. CB' Ik-A ofyoar <br />... iD 1h --JOII awe t1lo ""_," ~Imadl ofl.e'tua.~,.....1 <br />... r-1tiwt, CB' z",~..... <br /> <br />2. Upon ~ dIis 1~'&'II""w.. dto _ _daotl1J . supply it cm1y tit the <br />)If~..-.. Depanmeat atBnemat. Bowe'fer. 1IIIdcr dID FedamI R.... of <br />TA&~I--Jon Aareemont, die "'Iausad. of IfteDae .. supply this <br />z..",.......,~ tit dIo Tntenm1.R1mmao Sarvico; <br /> <br />3. F8iIme to 8Ipp1y t1ds inthrmldftm may .ieor-rdl". CB' cIeJay die p1IIll.......;..' at <br />'GIll' IiceJuIt i__...~ <br /> <br />PIeae ~ Ills jbIJowIng I1{onntIIIon flIIIl rBIPIm tiIongwllhyour tIpJJlIctItIon: <br />TYPBOFLICBNSBBBJNGAPPI.JEDPOaOl.RBNBWBD: ~ <br /> <br />'PRRfiII1NAT.1N1fn1IUATION: <br /> <br />AppIltxJnt"BNtltnB: . <br /> <br /> <br />AppIltxJnt's MtIraI1B: <br /> <br />StIt:k4 SeaIrI4Y Number. <br /> <br />BUSlNESS l'NAlIlv4TION: <br />BuslllBsBNtlIIIII: ~1Illot- '+\.Pc-*,~ LiA ~.,.,.. ('.u."," <br />......MtII8&9: loC\S 'l..oi-c.. At. <; 4> <br />~:\\a t1cJ <;SO~& <br />[CiIr) (S1&Ie) [ZIp] <br />Mb.-4cr. T_1tIBnIl/lt:t1Ik1lr1pi6eT: <<a1 'L ~ 1..'"\1- <br />Fer1mIlJ'_It16nt(JII:IIIINtIInbItr. --Lc --tg3'l. %\':'<<:;'2- <br /> <br />1/1I.JIII...8rAa T_ .w,. ~Ml1111JI1r 181l1i1 NpIN4 pkIse.""",.ths ftIIl8III'fI Blt1& <br /> <br />~ <br /> <br /> <br />I <br /> <br />0'9 <br />