HomeMy WebLinkAboutS04-Parks and Rec
-
-
_ :l..
CITY OF SAN BERORDINO - REQUEST Q)R COUNCIL ACTION
From: Annie F. Ramos, Director Subject: REPORT ON EVALUATION OF THE FACILITIES
AND OPERATIONS OF THE UTILITY PAYMENT
Dept: Parks, Recreation & Community Services AND POSTAL SERVICE CENTER.
Date: September 12, 1991
Synopsis of Previous Council action:
September 3, 1991
Staff directed to meet with citizen representatives
and report back to the Mayor and Council on the
evaluation and alternatives relative to the facilities
and operations of the Utility Payment and Postal Service
Center.
,
Recommended motion:
1. That the Utility Payment and Postal Service Center operations be discontinued
because of the lack of available funding for upgrading the physical security
of the facility and for hiring of an additional Cashier I.
OR
2. That funds in the amount of $40,549 be added to the Parks, Recreation and
Community Services Department budget from a source to be identified for the
purpose of upgrading the physical security of the facility ($13,500) and for
hiring one (1) additional Cashier I ($27,049) for the continued operation of
the Utility Payment and Postal Service Center. .. /1./ . '-.I '-7~
1(1(-"-1 ( l' .!!'!~
~.,. . Signature
Contact person: Ann i e F. Ramos
Supporting data attached: Staff Report
Phone:
5030
6
Ward:
FUNDING REQUIREMENTS:
Amount:
Source: (Acct. No.)
IAcct. DescriPtion)
Finance:
Council Notes:
75-0262
Agenda Item No.
~-'i
-
-
j
· CITY OF SAN BERtt)RDINO - REQUEST lOR COUNCIL ACTION
REPORT ON EVALUATION OF THE STAFF REPORT
FACILITIES AND OPERATIONS OF
THE UTILITY PAYMENT AND POSTAL
SERVICE CENTER.
At the September 3, 1991 Regular Meeting of the Mayor and
Common Council, Department Staff was directed to meet with
interested parties and report back the results of those
meetings, and to make recommendations relative to the contin-
uance or discontinuance of the services of the Utility
payment and Postal Service Center currently being operated as
a service of the Wests ide Community Service Center.
Department staff met with Councilwoman Pope-Ludlam and the
Northwest Redevelopment Project Area Committee on September
9, 1991. In addition, discussions were held with individuals
who were interested in the center's operations.
BACKGROUND
The operation of the Utility Payment and Postal Service
Center was transferred from the Treasurer's Office to the
Parks, Recreation and Community Services Department in
February 1991, due to budget constraints and a need to reduce
operating costs. The Center was merged into the space
occupied by the westside community Service Center.
During the ensuing months, the operations have been
evaluated as to security of the facility and security for the
employees involved with the handling of large amounts of
cash, and for staff and the procedures required to provide
for an effective and efficient operation.
In May and June 1991, the Finance Department performed an
audit of the Payment Center to review current procedures for
operations, control of funds, security of personnel and
equipment, and City Treasurer's procedures related to the
Payment Center. A copy of the Audit Report is Attachment #1
to this correspondence.
The findings, recommendations and conclusions of the Finance
Department Audit Report served to reinforce the evaluation of
the daily operations of the Center and the concerns of the
Administrative staff of the Parks, Recreation and Community
Services Department. The primary concern is for the security
of the employees.
The next most important concern is that the Payment Center is
not properly staffed to be able to give continuous effective
and efficient service to the customers without reducing
effectiveness in other administrative areas. The Payment
Center cannot be operated with only one cashier, and cur-
rently, clerks from the Department Administrative Services
75-0264
o
o
Division have been trained to assist in the operations. When
these clerks are used at the payment Center, their normal
duties are curtailed and there is a backlog of work to be
caught up when they return to their regular position. This
has caused some morale problems as well as increasing the
potential for error in handling of funds by those who are
assisting at the Payment Center on a temporary basis.
DISCUSSION
In order to upgrade the physical security of the facility,
the site was visited by staff from Facilities Management
Division and this Department to evaluate and determine needed
changes.
Facilities Management Division has provided an estimate of
costs for upgrading the physical security of the facility.
Attachment #2 is a copy of the estimate and description of
work to be performed. This upgrade will provide more
adequate physical security for employees, patrons and
operations. Cost to upgrade the facility is $13,500.
In order to bring staffing to a level which will provide for
a more efficient and effective operation, another Cashier I
position needs to be added. This will allow for two (2)
cashiers to be on duty at all times and will maintain con-
tinuity of operations when one cashier needs to be off duty
due to vacation or illness and temporary clerical help is
provided from the Department Administrative Services
Division. The cost of adding this position is approximately
$27,049
By adding the Cashier I position, the amount of time spent in
the Payment Center by the Center Manager would be reduced by
approximately one-half, thus allowing the manager to be more
effective in the overall operations and services offered by
the Westside Community Service Center. The clerical
assistance currently being provided from Department
Administrative Services Division would be reduced by 70%.
Attachment #3 is a cost analysis of the payment center
operations with the proposed upgrade of security and an
increase of one (1) Cashier I position. This proposal would
require an additional $40,549 be added to the Department
Budget.
At Attachment #4 is a current cost analysis of the operation
of the utility Payment and Postal Service Center. without
the foregoing upgrade of security and increased staffing, the
city is at extreme high risk of someone being hurt and/or the
loss of considerable amounts of funds. Should the decision
be made to terminate operation of the utility Payment and
Postal Service Center, the savings to be realized in the
Department Budget would be $30,657, primarily because there
would be a loss of one (1) Cashier I position.
-2-
-
o
o
.
CONCLUSION
Because of the physical security inadequacies
for an additional Cashier I to provide
effective services, there appears to
alternatives:
and the
efficient
be only
need
and
two
1.
That funds be
aspects of the
or
That operation
Service Center
appropriated to upgrade the physical
facility and hire another Cashier I,
2.
of the utility Payment and a Postal
be discontinued.
(STAFFRE:UTILITY)
9/12/91
-3-
- ~
o
D R A I' T
o
FINANCE DEPARTMENT
AUDIT REPORT
UTILITY COLLECTION CENTER
JUNE 24, 1991
ScoDe
1. Reviewed current procedures being applied at the collection Center
related to cashiering for utility bills.
2. Reviewed internal control procedures related to postal service.
3. Reviewed security of personnel and property at collection center.
4. Reviewed City Treasurer's procedures related to collection center.
Findinas
1. cashiering procedures - utility bills
A. Based on actual collections for the month of February 1991, it
appears that approximately $3,000,000 is receipted annually by
the center. Of that amount, approximately 78% or $2,340,000 of
the payments are received in cash.
B. Currently there is one full time cashier and three different
people working part time as needed at the center. One of these
people is the West Side Drop In Center Manager who is also
responsible for the daily deposit being made to the Treasurer's
office.
C. All of the people that use the registers have master keys to
both registers.
D. The cashier is also preparing the daily reconciliation sheet
submitted to the Treasurer's Office.
2. Internal control procedures - Postal Service
A.
Approximately $450,000 in postage
receipted annually through the
services as a contract station.
and postal money orders is
collection center's postal
B. All postal funds are maintained in separate register drawers,
as required by the postal contract.
c. Monies are deposited daily with the remittance being prepared
by the cashier.
,
D. The center maintains approximately $8,000 in postal inventory
consisting of stamps, envelopes and other postal materials.
This amount increases substantially during the christmas
-1-
Attachment #1
~
-
J
-
.
season. The~tal service audits the
verify the amount of accountability.
E. stamps and other postal inventory are sold between the two cash
registers during the day so that all postal sales are in one
drawer at the end of the day for remittance.
~ter periodically
to
F. Postal money orders are sold between drawers for the same
reason.
3. Security
A. Cashier windows are not secure. windows are loose in frame.
Door and frame into cashiering area are not metal.
B. There is a commercial alarm system. It functions as a break in
alarm at night, and a hold up alarm during business hours.
C. There is a security person in the lobby who is responsible for
the entire building. This person works for a contract service
provided by the building owner and is not responsible to the
collection center or the city.
D.
The door of the cashiering area
and is plainly visible. The
swinging gate made of plywood.
the gate.
is only six feet from the lobby
only obstacle in between is a
There is no latch or lock on
E. The only staff person with a view of the outside of the
cashiering area is the Drop In Center Information person.
4. Cashiering procedures - Treasurer's office
A. The Treasurer's Office receives funds from the collection
center on a daily basis via a Police Department delivery. The
Assistant Treasurer verifies the cash count and prepares the
deposit. Cash is deposited into the City's general account and
a check is written on that account payable to a special utility
collection account.
B. A cashier writes checks payable to each utility company for the
amount of cash collected. The city's check along with checks
received at the collection center are mailed with he corres-
ponding bill stubs to each utility on a daily basis.
Recommendations
1. Provide adequate staffing at collection center so proper separation
of duties can be obtained. Adequate internal control requires that
a different person be responsible for the reconciliation of daily
receipts than the one actually receiving the cash. In this case,
the center manager should not be performing both duties.
A.
This could be accomplished with
cashier, so that the center
cashiering duties.
the addition of one full time
manager could be relieved of
~
B.
Another
on the
switch
possible avenue
second window.
on the register
would be to
This could
to separate
-2-
use two part
be done by
the drawers
time cashiers
using the A-B
for account-
.
l
~
-
ability. A ~ing cashier could use dr~r A and an afternoon
cashier could~se drawer B. This would cause the second window
to be severely limited in postal services. It might be better
to make the second register responsible for utilities
collection only. A large sign would need to be posted in the
lobby to advise customers of the change in services offered.
2.
register keys for all cashiers. It
key usage should be reserved for the
register readings and reconciling the
Immediately stop using master
should be obvious that master
person responsible for taking
daily receipts.
3. Provide adequate physical security for personnel and cash. This
should include bullet proof windows at cashier stations, a secure
metal door that is not visible from the lobby, decreasing the easy
access from the lobby, a security camera system and a security
guard whose responsibility is limited to the cashiering area if
necessary.
4. Look into renegotiating the contracts with the utility companies
and Postal Service regarding the compensation.
5. Reprogram the registers to take advantage of the efficiencies and
internal controls available.
conclusions
1. The collection center in its present arrangement exposes the city
to tremendous risk. with very large amounts of cash available and
minimal security, the potential for robbery is obvious. with the
lack of internal control, the potential for mishandling of cash
always increases. This particular risk is currently very high.
The costs associated with reducing the physical security risks
would be high but would be one time costs. The costs of addressing
the internal control problems are also high but since they involve
additional personnel, they would be continuing costs from year to
year.
The cashiering operation in its current arrangement costs the city
approximately $70,000 annually. The offsetting revenues from the
utility companies and Postal Service total approximately $15,000.
The current contracts with the utility companies and Postal Service
specifically prohibit the city from charging any fee to the
consumer for the service.
2.
When the collection center was first established, it was offering a
service that was not available to west side residents. In the
subsequent years, the situation has changed. There is currently a
market and a check caShing company located in the shopping center
next door. They offer the same services, but charge a fee in order
to recover their costs. At the city's collection center, the
General Fund is SUbsidizing the operation. The question could be
raised as to why General Fund money is being spent to compete with
local businesses.
--
If the center were closed, the cost savings could amount to ,$40,000
annually in operating costs. The capital costs for reducing the
security risks would also be saved.
-3-
~
-
-
o
C I T Y
o
OF SAN BERNARDINO
INTEROFFICE MEMORANDUM
.
Facilities Management
NO. 11 .67
TO:
FROM:
Annie Ramos. Director Parks, Recreation 10 Comm. Services
Steven Grifim. Superintendent Facilities Management
SUBJECT:
DATE:
WBSTSIDE DROP-IN-CENTER
September 12, 1991
COPIES:
Fred Wilson, Acting Director, Facilities Management
In response to your
security level for
following:
request for an estimate on the costs of increasing the
the Westside drop-in-center, please review the
The increased security measures that we discussed centered around the
possibility of an armed robbery. The main areas of concern were:
1. Lack of protection against gun fire.
2. Inability to receive packages without opening the door to the drop-
in-center.
3. The exposure of parks and recreation personnel in the adjacent
area to potential risk of direct violence and or of being used as a
hostage.
Preventative measures required to secure the drop-in-center and the
parks and recreation office are as follows:
1. Remodel the existing park and recreation counter area to secure
the area from public traffic, including the addition of a door and
windows at the counter. Modify air conditioning ducts as required
Move the existing drop-in-center door to the rear of the center.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $3.750.00
2. Install 1-3116" bullet proof glass at all counter areas for both the
drop-in-center and the park and recreation counter.. $6.250.00
3. Install 318" steel plate on all areas under counters and above
except where glass is installed..............................$1.000.00
09-12-91
Attachment '2
o
o
.
Westside Drop-In-Center
Page - 2
4. Install a package retrieval system that would allow a package to be
dropped into a compartment from the outside and after the door is
secured, be able to open a second door on the inside to enable
center personnel to retrieve the package for processing
.................................................... $2,500.00
Total cost of the project................................. -. .
$13,500.00
All estimates include material, labor, and tax. Installation of glass
materials to be installed by a glass contractor.
If I can be of any further service, or answer any other questions
regarding this project, please let me know.
~
~ .
STEVER GRI , Superintendent
Facilities Management
SG:mal
File: Corrsp. I-B #12
Maint. 8 #5
09-12-91
Attachment
12
o
o
.
PROPOSED OPERATING COSTS
utility Payment and Postal Service Center
Personnel Costs
Two (2) Cashier I
One (1) Center Manager (1/4 time)
One (1) Clerical (as needed)
Total
Materials, Services & Supplies
Postage
Printing
Equipment Maintenance
Security Services
Office Supplies
Mileage Reimbursement
Telephone Charges
Space (25%)
Total
$ 5,622
$ 500
$ 13,500
$ 87,316
Equipment and System Replacement
Capital Improvement-upgrade of Physical Security
Total
* The Center Manager, clerical assistance and space rental are in-kind
services and charges which are directly related to operation of the
utility and Postal Services Center. The positions and space are
already budgeted for authorized department expenditures for the oper-
ation of the Wests ide Community Service Center and the Department
Administrative Services Division. These costs would be ~n the
Department Budget even if the utility Payment Center were not in exist-
ence. The positions and space are budgeted for the larger Department
and Community Services functions and their time and use for the utility
Payment and Postal Center is an additional duty assignment because of
the requirements of the utility Payment and Postal operations.
Thus, the additional costs which would be required in the Parks,
Recreation and Community Services Department should the utility Payment
and Postal Service Center be maintained with the security environment
being upgraded and the staff increased are:
One (1) Cashier I
upgrade of Physical Security of
Facility
$ 27,049
Total
$ 13,500
$ 40,549
9/12/91
Attachment #3
I J.
'11
.
o
o
\
CURRENT OPERATING COSTS
Utility Payment and Postal Service Center
Personnel Costs
One (1) Cashier I
One (1) Center Manager (1/2 time)
One (1) Clerical (as needed)
Total
Materials, Services & Supplies
postage
Printing
Equipment Maintenance
Security Services
Office Supplies
Mileage Reimbursement
Telephone Charges
Space (25%)
Total
Equipment and system Replacement
Total
* The Center Manager, clerical assistance and space rental are in-kind
services and charges which are directly related to operation of the
Utility and Postal Services Center. The positions and space are
already budgeted for authorized department expenditures for the oper-
ation of the Wests ide Community Service Center and the Department
Administrative Services Division. These costs would be in the
Department Budget even if the Utility Payment Center were not in exist-
ence. The positions and space are budgeted for the larger Department
and Community Services functions and their time and use for the Utility
Payment and Postal Center is an additional duty assignment because of
the requirements of the Utility payment and Postal operations.
Thus, the savings which would be realized in the Parks, Recreation and
Community Services Department should the utility Payment and Postal
Service Center be closed are:
One (1) Cashier I
Materials, Services & Supplies
Equipment & System replacement
Total
$ 27,049
3,108
500
$ 30,657
9/12/91
Attachment #4
.
.
---.
...
J
JJ.
o
o
PET I T ION
{Lf
TO: THE MAYOR ~ COUNCIL
SEPT 3, 1991
}-
We, the undersigned, hereby sincerely request and petiti.c.n the
Mayor and Council for your consideration and determination on behalf
,
of the Postal and Utility Station, located in the Public Enterprise
Building, in conjunction with the following points of information:
1). This is a direct benefit to the local community and to the
society at large to continue the operation of this utility station.
This is the only economical outlet the 6th ward serves toward the
support of the City of San Bernardino.
As we are aware this center generates thousands of dollars per
month, which the city benefits from. Therefore ~e are requesting
that this utility station remain open, and allow the Westside of San
Bernardino to remain in the mainstream and grow within this county
and city.
2). The city is well aware that this center has been part of our
community over 15 years and has been victimized only by moving from
one location to another.
But the success rate of this utility
station has remained a constant flow .::of revenue to the city.
3). An additional point of information is that jobs have been
developed through this postal utility station which is a must for
'I
? :
,/
this ward.
In light of the aforestated information, we the undersigned
respectfully request that you, the mayor and council, sincerely
consider the postal utility station remaining open.
Respectfully submitted,
nlVl \ (" L ~M 101 LR.
5- )../
9/H,';? l'
^.
..
4S'D.O
o
~ Name
Addyess
Phone #
SignatuYe
.~ ~1i!iE~~~?=~;ZiE~ji/!!;l-f;~
3 .~___H~___ ________ __L!i.'ip-~A~dh,Y___~~2~i~____
i ~!!1Pl~- _.L~"_~<:<'=II.
~~~~t,J.l~~r.!L1-L~ff.fd_~_:Sf!J _______%:l:2~313
6 __~-~/2tc~-J~~~-~"'!.LLr .~__E..~li-l924>
7 ~~---.I.8..z<L~~-c;)L;J-re.-s,f1-'!:I-~~~~~~l-et.-~---- --
r'j-.:t~1__L_-J.~s;.-~..r__l~5_t-_LJ_JLLC;_l-.N_~__SL_~8-S:.17 9.j-
q L2~__~__QlC2~_~~-&::---~~-
", " r ,,//
/0 ... --- ----------------------------------------
II _ . __c.CT~----LS.:t.fI---Jl.a.,()CflCkC.-sL--g./J8
j;;' __' ~#~nt:L_.~~2--d-~ -~-~~.
13 5L~-€:-![. _______-2,JIP-L ' . Er-- /
If~_JL.--'t~ ____~__.___l.~~_~__P!L'2~::'____. -
iP~---C ~ ___.ds:.7.L1_JJL_7l1d:A <W )j_~-'k 'd~~ ~,. q~u-
I "
I'~-j). - ___l5":..3.JJ._J.tV-../.J:f~4rY!r-;;~ALN J 7 ~ Jj-/J
~-- - ~----I-P-FP.-Mff~714 p;-41J- (7~ rotJl-vd
_ _ _ ..L~.f.::::._'f2.__.__~__;?,::..B--$-~!f-Q.-~--
-I..L~--/:4A~ ~(j f.,lt'LAJl:"-------------
159!5.__G~u I. ~------~.6-----
- 2~J3-lh~~~---S~O ~'p;z.~dS-
~-1(($!,Lr---UH~~-g.:1.'" //
~~!j-~ - ~
- --I!l~-Ai---4 ,--SA'. C?~ YI/
---~-------- ._--~---------_..__._---------- ---------------
A1~ii~::~:~--
':J..D.-!--W-V~..&t:--
~3
tAt
~6-
;;. lP._
. ;'7
cAJ'
~
_ J.
~ tlII
.--
-
-
)
"
o
o
# Name
Add\" f:-~S5
F'hone #:
Signature
--- --------------~-------------------------------------------------
po r --- -._~ If. ~ ~fr---L.!-f-~=---~~:kn:.4::------------------------
5~ _ ___ ~_.!..?=f_t_~:..?::_4..~~lL:.50d~~.!:.~:..J;;~_q_2:._::._.[ C1,j-
g f ' '::J.Lf2__c.u._.$-ti-jLE.__~_'1.L8d.&o__q~q6 ~
~-tl_~___~~t:?_-e;;~ed~Ml.t,;_:::::u'__5.~_&_J 't,' ~
.J} - C),,9-ff--h.__Q~_9_-L_9-B_Lfl._c:t--~ c,c (fa
~1 _ U t. Q[l.. (S:-.a.&.~~_~_.G___________g_a~_lL
I --~~ . .
~ 'j2 __~--P~L7-7-!L.w-J,.22..t-...b.$+--tfd.1:."'O 5
a"-R~J~-~~-~2~!-{(~~~---S~-~~~:~ s-'
:~f1~~~~~~~lI~t~Ul2~4~~:M3.l-Y .:5
~ 1 ---~-~A-1---I1k~q.--~-#--:l~" j---
tf~ ....df1l-4'_-u..~~~$.~~JL.:lL.2.fL...w...-.li:;n.cal..'2J-.5I-.2.e2..'iLL~./l72 8I~a.
.,1 f!U.}jL~~ -':!.~Z-~-Lr1~P,$-~--9!k~:A'f:-----~
t/~ _1J;j_~__~~_____J:J.z~__rl~~_~~_~__-q '- &;.
i!> ~-1L~-~--J'i~~~:i:Jp.eiL-----------,-- ~ 't f(
~/ ~fu;;~:;l~~s~TI~;?;~&
#6 _~_L2d~~~_:C__~:;~,~
I/-~. -------<ALY:!lg)c{~-cI1'-JkfdQ~ ~
4(4~ __ __~~___._~k..c:./.k7.t.J2f_~Jl~ p..,
tf1-s:1~__.___~.___!Jf6_S__{~~~__i!.~_~4!.~{J~ ~ .
s"D m~_~. .~________J_~'--_ul.___.!!:-1..iP-~~_~~ I ~.
.37 _?/)~__~~______~!.~!k_Iff.~_~R~
.!/;;..~~ 13'1'1_ __ _~__~ ,-_~C4
~/- -- +-4--Ce4- s..L(:::--
..!.~~=_.:.________ _ Lf.P-?_~:.._'t.!!!.f..~!:"___€~__JlP.!:!'p-_~!r '92'11/
~~-------------------~-~~-~-~~~:-~-~~-~-~~----------
.n ______~-, l~.) .&-:._:::____l~J!2~__~__~____~_~_'_~~_~ ;z.~H I
~7_~~~j~t!~~__~~1~1__~~~_~~a~~)lt~~~~--------------------------
!J -( ~____~~~~f::L~L~--.-----------------------------
~ JJ).-~ _____-'-~_~!iJ~:Lk/.ly.&:._s~---------------
. - -1J~I_-AA~_-_-~~-J1-T.-.-----__-9~?:--lL---- ,
M ~#:__.2g'j(~!!!..f__~___ ~'("f!Ar:;, -< C A~__2=~2.~_ -
~:JQb.tlId_t{l._Al"-'-t..Rtt--l?___'L~~_~_J3_!._~_A~L~~...*'-ci
63 _~--~tbJ----19JkJlttti-2Jp~--~~--~8----&J..~~-9.t.:ll1
(pi _1l0'!.'\n..Q,,_~~~",-__1~.'Lb..__~\sl.~__i."'L_~..!_~,,-~""'1.9_C____________
V>~ _~_./J.<6.~_J.J.l,-L~J~2:!~__S..&__J.~'t..LL___.:._
M. k~-h-2{~~dSA--9-J.?!?)...L---
(,1.... ..~~d_._L'-:lJ.J.._~__U...__"S:.l~_Clt.._7d:!tLL______
6( .-J A.:.J1I.A;li~~.,~__.LfjL.Z.b J, , ~/f-__It__s:!!.._~r_~.'</j_t_
1 -- -- .----------- -- - ---- ------2- ~- -------------------
~ . L
--( ,/I - ;{ ~j {jJ}~sf ~/3 -~-~-------------""--
.' 1:3 - ---- .-~.-~----------------------------""--------------
.I 7t __ ._. . _ ____lQ!ti~~~~~_r_;5_~__ctt------------
1~___,._ - ~__ "C!__ -C-ll~d~S.{------;7
16.___ _________ _~~~~__~~___
71 --~tt L.Il!J..rL_..LY___:b-2'kJ_tft4-t!?IA_'":!:.__~=:2!.2:6-_::.____________
7( r ~~~
19~_~~~___~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~_~_____~______~:g.%;_~L_______
__~_~4.-_JSM__J1..ilA&,__,_,.b'J:!.__________
(.1-___J\JlJ....__ W~:1~-:l--~-.s,.I>-d~L_-----
(3 VE J) ~ C"I
--........I.~ --. - -~. - . c .... ~ .L:,:!?-..3~f-t.J2/.?F;T~L------
(>~ri)~~;;.-<fli~~-A~=:::it::-':]s~f2~~t'1 f
111-
_ II. lI11
-
~ ..
o
o
# Name
Addyess
Phc,ne II
SignatL\ye
\
.~
's,"C,_
tJl .,4
~ .
ill JIl 41
.~
o
o
Phone lI~NS3'Signature
fb-- ~ - _E~~71~__~~ ~-------
fI-- ~JJh--~----i3-~X-JJl'--WaJl---AueL~-,Jl..------------
f(--?5~ ----~L~~~rfUdL--Jd;J.t2!;-------------
&f .:~_ A --------~~~--~--{5L--~E-----------------__
qo. L~~ __t_~;r_~~----:l~1---------------
q ( .--- . _______~ ________L-2"$:".L_&-s6~_s:_A_<___________
f" --- 1-:. ? ___L!L';'.!:LJLIL~_oI_61L____________________
~L. - --'gf-:637~~12LL~E
q4 J_~ . ___-;__1122___ _______ __~_:2~-.jlgP/
tf{~~--2.3.q.k-e~-~~A._2_~Cf/ (
q~ ~~-~k~..3~..~3--hl..-0-r.CJ:n5\.j:n-~~:-.8g-~-(QJ-~-9dlj-Qr
~~ __Il--4L.""--___Ii~J:.rf----~~--'iZ-AL-c:;L~~l(.!/..:ew---~J4---Zkk1"'4v'-&Lxld 7' d <7<11
q{- - Jipf&h4%!lL{!1.k{Jjl-~Ltbx-I3.~---~-;b-
~----~-- _~!3~Q_H~~-!2=/
I - ~_),(LK___,t~_____~__-,________
iii . -~~j.t.kftIJ~A7'..oS~5~~. 0
IbY- - - ---- - ~~~--Cr------t-J~L~ - --- j(J/3f
IO~ . .-TI/i.,-~-----:~--._~--Lt~tj_--~-~------------------- 1
/O'1__rL~q__~cfY.__122!L__rt.'f._~~__________________
JOi___L~_~~__c2Q'!-!L~~_____________.___________________
lOb ~ r 1,,->-q') . 0'_ ~
PI ~~~~----- ~~~~-:-;::2iLS-A1i~~~:~:~d~f do J; Mt-.
IIJ(~ _ -j-!-:t-y.L-?UL---L!:L~J-j;.-_----- ~
~~~~-c-lf~_l~i~~~~~~~~ri~~~~i~~~~~~~~
11/_-'3~_~_______'-DL'iJ,t;L_~~_~L~.k113-L1:Q...._C..a_S?Z.1 ?f
1,,""~_El~.':::m~R-~~-LL.fj-~~M=-2;2!1J-J__
1/2___ ~---~~-S.l----~r--~--iJ--.s~-t:L--~\()5
td ____ ~_____~3:..12_~;M_~_~-----5:2~{k-----
ii.cc. ".-
B _
..L.
1.. 11
J.-
o
o
# Name Addyess Phone It SignatuYe r
IJ~~-~-~ '- __.2Lf~_-'L_~~L~fzL__.t:!:.?:-_~>!.:f______~~
lib _~__ lff3.LiJ~4---25(~~J!2Pk-~~
H1__~~ ' ___!!_L_~_~~_______________________
p{_d~_~~_ ' _'t1Ly,)_,-r::tL~_si__________1Ktl_~&xtp___
P~------~1~-- -------------------------------------
J~___r4L~-----~-~t--Ii------J!.<fd...'=-~?KQ.----------
IrL_~d _ ___2_~%_L_tl~Q2/:.__.f2:l__S!,.f!Lt!..__~?:.~
P'-.::__~ ;;L 3_~L[M~j:L&__~_~~~__?};!iPA:----
1~2__ - \'i~Q.~~~~\.~--~~~-~~-=tlL---- k>
j9-l " - ~J~---2-f-fa/_LP4-S!:!-';>
13b/ - ",/*____L.zLi__C'LfJ:.o..~__~~t?.__5J3J>-o ---
, 3_Q._~~~.:________
I :t r
I~ ~~ ___________j_~D_l__ _ _
I~ ______~~~ ___~1tL--~- ~~-----
- -< - (----------tkC?:LiL::-5:ilIL--"iZ:.-.;.------n
'/~' .- . -r--L~--~-=--~.Q-----~-~---""-- ~ f-:t
- ~4 -- --~-----J_~~4f-.----i3.-J~ i& :.5
I~ , ~sL-!!d!-/L..A:-::-S'\--JJS'3--f1-"!d~~~?.fi~-if~"'-(JL~-2~-~.2~
Ia'? - 112~-sikLL~-U.2--i--_---------~:gJ-C1-i2t#-..//
r~f ' ~--):;-;~~--ffi~_dL~-~-M L_~83' 7-6
I~ _~--~----~1-<?-~~--~~~~-t1-\(~-~-----------------
'::i~dr4T>---t2gg---~A{-~-----------~?7-i5qij7-------
---~- ,--- --i-~--1~--)---f2L1~----------------------
I~'- ' U'<1J -LLCZc..td.L~___~~~f'Lr.l3__
I~ t.lt!k.l-_w~ j--=-~-----------------n--------------:;7.---dh---
ItIc Q:\.._ ~_____1.6-":tL_r'nID!l_____~.Q._:Z-.lJ.2:L7
If 1 _ I l?J:l_tl.J!!&_~__M-_C&______
If3-' 3 t7J~_~!~~_~___________
I~. ~__ - ~----~-$-~-------------------------------
_"-~7 -
-
o
o
~~d~ess Phone # Si e
~__~_4can_J2l~_!;&__i~2Ji.t..(f . .
~~_diL.J:_~.1w-UiLft.eL---s;.~>---F.?:.1--~-
I'll:, _ fYI. ~_Jt?qL_c.y_.__1Q~_~__.:_~_'?___J2:!l.P.:f___
/'11 "",-_~~___LI1,J:U..,L.t9._~_____________~_~__~li_\.-_
/4(___ _;;_~___J_'b_'L~_~~_2i~____S'-JL_____t::t~__
Ie{. 'U-~_~L~~____1/f2.E.ljl:_'>>1~f)l:._2.~_~j_~___
,)7)IfL~~---=-_tlillPJI!cI!:f_.JL__~~.FJJ~_d__.,.-_________
1~1/1lM, . L1i~__.s$~~~~~-----[;i-{]!)~C------
I~ ____~~!___~J_~~--------~-~~-----------
I!) - -j7.IK~0r----__.sJHtJ'd/.!!Q___-
1~1 - ---------)37;;2 - '.d,d._____~~---
112 ~AAJ j~!L2---t;P::b2~------2~---------------
156 ~___ ~____.&tL_'11L~-------~~-'----5dfLe:.?-
,57 -.t..a.+:E---M.9-LlN------------------------------------------------
15( __t;;~_\.'>f..Y.:::\..__p_"L"'=~__~LLL~--.D.:=,.Lb....:::T----~.!.---:2..~~
p7...J.J1dL ('~~"'__________~!LL__~_.t2B:c.b_)'_.;.--"2.L!L---1.J,SR.~---:--
,/,b c9~n~ _~'-------eijlL-.Ld.L--J2Ac.i:J/---$../-!:l---.i~!/.12S------
16/ 6~ . ~____JLX~.L~___j_..L~r_;$.:.t2'_Z<?JJ!_()_S____
/17').& . ~----~-~~2-~~-si---~?d---22:~82L--
/b,? B(l~.v.----gti8Z--~---~---~:.B--2~~-
",'7 ~cL~__i&.:~s..t"z...__~~~~L~tL~2____'_l___~_~"'_.!~_:l~_l___
I~ ~ ~-L~L~1Z~--d~..f:----2.dLf:'LL-
16 rz~_4 __ _~.tf%-H:_a .J_&tff-_!l~!e./J_9-=___. -'
I/''/J ~_cX. _~~_t1, ~(dJA::L~~-5JJL~6.L2dJltJ3
I/'( _ ~ _ (~-U,2..\ - -r.:;!___________
~ rr "L/ 1/ fL- Jl'. rf::l-
1,9 -7)---------LfefLa.-../-l---#1-~-~ -------:...-------
170 _~~---t.~.l!L--.id~-Hjz---d--~~-~~Ptij /
11/ ~---!~~~~~~---~---------------
1'1/)-~~-.d!t-~---.i~~-b.--ttL-.r~~-~-.s.-~~---
-#4
~.. . ~.
o
o
# Name Address Phone # Signature
/13-_?l~_~___~Cj::LPL~d5./44t/:3.~~!.--------------
lH/f~~-2':f7---o/~b"---i:ir1=f-Jh..~'-----------
:~ _ - '~~~-;~2:~-;l~~~~~aii~zdi~~~~~~~~~~~~~
/7 __ ~~~_.!!_f!L_fd..J.k.~L___h.K.::.2Y..2.X_________ .
11( __~_~.1J.;.~5.:_Cu '--9f....7:i..:33.J-------
/79 -7()~-.?;;b-~---L---&j{;-e~--------------
1~__~_~____~~~~~~----b1?~~------------------
fit __'?}L~~~1J---~fd...r..--jL------j.l.--------------------
~4~-la&!:?L-Lf:lf:=ff:,LjJ....t!!.:::---.cdi3-f.qyL!.-------------
I~ _.~~---~..---J.S:-].€::-(!.Ljl/-C!!..-=--.5&--------------------
Iff _~ ._ _______56_______________________
116 M~ _ W'..w'04J_L__2t!.P-_g~_d~~!l:::Lc:~__;=.JSt~~!J:;L.'9-c:;.{j. 7.2U<:l ~ V-
,: ~ . ~_;:~'7/J;;-?~t=~~~~~~
Jrr*I-4/.L"'JLL2gLf----dk.1>'-~=d,.,-:::..J-]):v"",."":d'7-a-:z""" t. I
I(f - 3'2,eit:~1.jL~/M..:L--/A~_r..-,iL,..~--.s~-2JuL"dCdt..7-~A--7-4d6
19'0 ~g- ~a-<:.,---------!~.------.!!.-------~2.-----------~::.---~:..---
,q I ..&~.6.dk__~-"_":JIL1._______________________________________________
I'll .-~~-'fl . ___12.9..{).._.w_2___________~__rQJf,o.r.--
/f61_Zt:!~J..f.._#..k!!i~_______'5~L1..__~L::-Sk~,,:t::-~'2--jlf!a>3.c.L"7.c.4
19(, ( _~ ~o tLS:----~{xi!-'J:;~~ Sb.f..LC--&.21er..,a,u.J.;r-.&J--C4
If7 ~1. _~ '... _ --,ffis..i.d _ dt;g___!..L____LL_______
If~ _~~~~__~~~------L~~9-- _~1 _. L~---~----------
If'! ~---~-:l..~-.Q5- ___ ___________S~---
~ _~eJ-..~-t"-~t- S~~---------
II-' I ':i!j~i2"L-'i.---2g:2~-- I, .--:--'~_
_~;.C'..",..'O'.'.",.-'--
JIIJ .
, ...l.
L
o
o
# Name
Address
Phone #
Si gnat ur e
BP~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
jll_~__~_________~_______________________________
:'- ~~~~dt:::~::~~
~--ft1~-~~--~LS------------------
;07____ _~~-~-----------------------------------
u( / ~__~_~_:i_~_5t:_s.~=-___~~
/~or__~~ ~~ _____~--~-~L~---------~--- C
~(D j__LCZ_'l-4L_II-~__~~~ ~
;"/J __
:::~T "~_ - ~~j~:t~~kA ~
pi -J!:;;2 _________3.~"b.f~ 3_-~-4--
: -~'l--~=;i ~jf~t~';r0:lf"1.c-!:cc .
I ~~-~~--~;------~-;~----,;---------~-~----
Jrr;?df:. - - ~__~~'%.--------,.s----sJ.d.--------- s
~~ -' --~-./s..~i--"2!fLr~--!LvL;6~
;21 q _~-------- d.______________~~__?:~___:='?:k::__'_e2~_~~__F0 C
.J.)i) _~ _Id.faS._ :#~1~_~~-------
M ___. _ -L~-~--Z~'L~-L-----------------
::~ ~4aoy,_: - ____d_$fi~:E~:JJilli.::3Ri~ (,.
,p.~b~~i1 -- 9I.sBQ~--~7:Q12lo---------
f}:P1___~_m c.. _ __ ___L$_Ra-=-_~::.____' _ _~.?:1 <II)
~:~f;;;;;_"it~;!:!:.~~d:5!~~~:-i~:~~~~~
,~> ....- .
11 ..4ll1
II!
u
"
o
o
*~ Name
Address
Phone 1I
Signature
---- -----------------------------~--------------------------------
~- ,---
IJI, Ul
-
"..-
0-
o
Address ~. }. I' Phc,ne# Si
I _ _ S~.M.IL';-MlJIl:IA-2Ztt:.ff.. ,
/ L' ./ J ~ i _...f c:: )..,.
.!;.&(./,--. ~.Jtt~-_._~-4)------------
3 _~ -3:ZL~~-IY...Lisl~-" ~~,-s:Uf-___%x:.Z-p-rff cfJ
c--- __}~j'.!.t_N__~~___KLf.:J<i;;~________
- - ~--~---LlIJ.-'J~-e-i!ar-g;---_-#!1-!!:.fC-__- .
~~AJ_-:b.Aitt._LtJ1kJJJ_______sl.fl{:_~______fif-1-~~__
7_.& ~ ~ -..3..~Q;. ~ -~~J.--L;.-~-Si.--g2=i~ ~
1_-Pt.f.LJIa7::A-___JaM./l14:.----------------.a.<is./P---~~-~<;;:L--
cr " _~-""LrL~:..~-~:?-.fl-=--~-2:::I-te:--
! . _.ll<1~_~_3_~__~___.U:l__~l\.~~--9:..---
(l . _ M'~A~t....~-/s.'zi~-J.JJ.-Ol.f~f;ft'tJ.=---'2L)-=-Cj.s.C(fs
/ ~Lll&J::2_~_~Ij~~<:'ij!_:!:.c___:Z_{:f..t?__.s.6J..L{_~~&.:a_t!.._t?:!:...___~ - S'?z..
W#~-_R72Z~~-----LX~Z.--2L.J:.C~~-~-~~ ea.
I i!~_~.!~__/z.~9-_S'-_4,)A-'-er~L-~J2-c&.~ erR.
~il(fi-J1f{?~-dAir.Jv...--t.~2.S.:.Jkt-B/d:'-~c/,?;--1-~-&~ CZt(
1'!G,r;' ~----------..2..!5.!!...-:k~.L~~~~d/' ~
1 ____ ____ _____________:3_~~2____~___f__!__::._=_~J:___=__~!:::~__~
__-L222::-~-I:/~S' -=- ~A.
I _~~ ;2M:.--:Ii4.,1.5Pt2~ - ~
~ -----~-- ----- ----J-~~~~-~~.---il--- -
:1-1_ - -f2~CY-- __1s...0_L_w.___JJJL~;i..-;2L-5.~jjd()
'- _L~__ !E87.-~~-~---r1!LCZ,lPl-----7}J..l) I /
~ _ -==-5i~:~J~(l!Jl~~~~~d~, ~'-111
_ _1:-__ ~___~---J9.2~LlldtY.M-S-t-'2{j~L~ 1 ;Z~05r
_________~M____~___.!:!.~~____~~___~___~~ Ff':HI-rK
TfjJr--AJ~------~~-7.b:':f. A-<:C(J-LI.-__~__~~~____~7 0 I
2_l:i~_51~______________1]J_1_~__~;~~s..t-.L~J:f---j!.l~L
~~~r-'--~~KM~--qc-~ . {"~~.;.~~.M.-#
-__ 4
u
J
-
O'
o
Address . Phone # Signature
~ ---~~~~~--------------------------
~ mrard/;
j ----~~~-~\J~~OL---------------------
,25
~k_
J
3[ __________________________________________
J __ ___~__ ___________jJJf.f~P;.~-~'{.~L-J!.'fff!~'L f?J'~
~i..~JLs1MJh.~.5ifi]:f.~L ~:
~ _ __7.fL~L.h~_~..__~~_~~_ --- - '-- "\
-:fi;I~)) _j!/J.Lt.'lttA__;!~32_~CAI.."cL1L.&IJA---s..B-CaJ-.!~
~-!2 l-
..
\
..J ~
-
0-
o
*" Name
Address
Phone *"
Signature
~<f.'s..iJ:.__!Y.l:..JJJ.So..d.E..s:.____________'z.W__c:.f{%_~_72._~_________
b Q' l~d:-___ __I:f::!A.;i.Al~!:!l-Lq.A:l.--.I3::l:::..C--~-~-'::'& <t ;. 4 I(
~y ~&~~~~Z~~~
----- -- --- -------------------------------------------------- ~
__ __ _~~--- c&..J~-0'~-~2'L<C>>!_~~~
~~~ - ------------------- -----------------
_ ~~ ~ w .Jj..A.,..-_____1.lk~--~ __ ____~j),__}_~.!S
"b - _ ________~...Q---c.~.lLi5J. .A-_-2.B._~Y.PY
~ ______ _~-----------21i!iO-.....CARVJ/JlfL5..T..---1---'P--t.2..#Pt;
b3____jl_~~---------j(j:1E-'i--------2LIR--:.l'l!L1!.!J-
~~~-=-----B;l~~~~~~~~~~=~~~~~~
. ~ -' -- -----------------------------------------
, ;~~~~--~/--- _4L~----~-------------~-----------------
:'/3I;~---~---------~7.s..--JJ:Y.l-:7_-~& ~--J4!----0Zc
~ t !4~--~---~~---L~-;?;}l----!1----J-B-
;'~-~2d~1-wy1-----;-s;{~~s~
~ __~LwLd.J-ZL~-----~~--~L-----
77 ./ _L' rL":C- ~~ cJ. ' ..Y ./
_~_t:d.L~-J.2.L'$.-------~-..:::o:.-~./-.--
7t___~---~~~2.zZ.-~-~~~--L~~. .
71__~-----. _ .:z~~-#~---L~::.L~ 15
g0-i4?~- _.:.~4U~--38.f.t2.-'-..J/J.n..o:.--...s:L.0l!l~a..:-.33 IS
'?~~___~ ~~ll.&LA{i.\.L$>!b
~ ~. _ __LfJt1.__td..!d~~L.!_6ilU.&r..!.!Pt';, ~Id.f
&3 - ~_______2.L2~..& _ _' _S-.au~t
g . -- -. -r -"" "- L~~:c~--?':~.-~~!..~:.'!.!:.~ p,
- ' t'l~ - '-Lq-CZ-':!-..::m. A__.s.:J)._c..~-----
1~~ __ _ --J!d- ~i&::::-
, ______________________________-1_~::!.6._J:2~~----J:di:.2~ Lf ( ~
\
....-
0"
o
# Name ,Address Phone # Signature
. rl . ~ ili 'c,y\1 -
~'6 _.m.a.~____~~______~lli~________________~'l.-~~\J:t .
~~~~ ----~
Cj V -a __13 ~-j~{aLuJ.LdL--~Jf1tC2.-q;;/(/ II
~ r ___ ___~___~_________________3.L:!_9__KE..r3J:L=-_~f:___Q~15 9~ 'i-1J ~
qa- ~___!.lI.ak______ji/i.1-:..fY.d.~d..c.__caI________ ' .
~~o/~-~-:?-.:Lj{"L:1.LJ:;:S!f!~LS.~...B.~1L;2=--1-?:- ~ tI f
qtj ~-~.d~ ~~~ __1.k1..L__t:K~~~_~_~~!I...IL
4'0.(" ~___~ ______2..L7S_~0.:.s..J.z.LALm&__r$f_l;LCjL~;}J..LI1 /
4~ .zz..~__ ~ __.l.;Alj.K__~_..'3L_ __ d '7;;'1(1/
17 W _ ~,q:n _ _____13j.%jl!J!L~ _ -__ _C-._P'll/ .
1Y ____ ~Lf~ __Le..~_::L~~___~_I:::.(,J?df tf
q~ _ _ _ ____ _~_____L_2f~__!Z____________~~-O____~~/1
~:~-~- ~ -------4tr--f __ __-.!L_~~_
I03_~~___ __ _ __________l_~-~~--&}.l-~~--~-~~--~-~-~-L(
I~ _~~_ .;. _ _ __./S2.r~-~Ji.7!-~r:.!;2..s:~---~:LJeu-J re ~c- 'C
:1_ ~' -~-~~~~~~~
IO<(~~3:.__ _ _~~Y:(--u.t.-~-~~~~~~~
/01 =_~ _ __~~___SL__~l_~_lQ_"3.ShL~=t..l!?n.---~f'n.-.Be.~l:\ "I\JO
II 0 .. -~_~~---:-L1.~ii.-Jd.:..-23:-~--5~--t$;.!;a~JR'-':!12-/!Z.~S ~ __
L\ \ ___I __~~_r./Ll1!:1D1J:..MJi.!):rL'.J).!Jf/i,XJ/!-L~~ ~~
I' '- _ !Ikd'/2~[Jd4t<</1~at..----jg~Z--f1/e:;r...d!S.---J~ 9 ~JjJ6
\\3 _~~~~~----1-~-2~--~--~~~--:-----------------
u 4 _=1..P.:~Q_~X--~.....--(lA~~-----.1.q--1-0--1!J..-.Y.:!~.9..~.h.~\~-~-~ \J.
ll'; rO}.QL!.CfO-!.J.JL.r;;..f'.,.oL~__LI~2I.JL_Rir.~_.zJ2.3:._~Y.2.l} ./ ~ ..
l{rl_.t.i~~j,0--~J~J{}J.LD_~~~-1~ .
-
L
O. 0
Address M '. Phc.ne 4* Signature
1/ ~~Jj)J/lf/2~/.T53&}~-~~2------
/I~ _ __ ~_ _ _ Ji.55J12j1.t:-51i--tL~:2f!?:Z-----
1ft _ _ ___ _ _ _ ~jj53/Jl.jf2J~J?{_I!4s.t.______
I~ :;P,-A--~CL&----(iLZ~Ll4Lit71~sL--.:1&g---~:}.1~------
~~ C~~ ~--- --- ~_-/ff~-l~~-<8-.r;.~~--~~~~----
~________~:L_~~_~~____~]LL~_______~__
1:J3 _ J::l__~_J.:nLJcJ.;.fo~jk:l.l-Ssl:,----~JJQ--:.Iss:t!::/.--
1:Pt t1i:~.JJJ.L-0,- fl.__L~~Z_Id~_~_~__~~__'?!19-~
f.2?~~_1t~ ,_~_!::1d...L~, _-;_~g~___8ft.J:3.Lr.p__
r~ __~~ _ .i.!l,c~~_~~L4J_~.sP2=- J 1/2.
(:t-7 __'.di&~_..b_rJ.I&c___ 12. __~~JL49.1.~~--------~~1l~~-
I~~_ _______________ _ __ ___~~J_~__~QL(\--~-~r11:c~---~
J~r _ _ -. _~_<S~~1_ _ ~
I~ _ __~\l_l.=LL--- - ~
to Yrk~-.15-'I35-~.N-'k.-J~---- .~
J; __.i::Z.~ _ __'ZJ..__2._r5LS::_~!:Y:::_--------':l~..r ~
m> ~_ _ _ ._____'1!iLL__'r!111!.~~Ik...1..L_t?;J.2S_
191- ;B~-(J ~{!f5t-~-.3Ce-.lJ.{Le-.s.~-~~-p6~S-'
13.~# _____:::_2.5.27--E~4.H.Jk~~h..Bfi'.tacd./?.D.I.~Y'.::J"_;Io..s'
/3- Y_~_1J-~_Z.3.;L1~..L:_L~J3....-tt:AJj2-;"'--------------------
{~7 _ ~ ~&__ ~_~_~--3-:'~;t--5d:{~5-
:~V__ _~~A. - -~-f~~~.:3~~-~->>--~~-A~~~rft
__ ---~ - -----l--~<1.JfIL:J2L-------- 1:; j6A
(~--,-- - ~- -=-!.2TZ.-)):!.yjd.A~----~-~tJ~-:------------
/tt ~_..~.I.1i:fLJl!.1~;.<5t-4~.s!.:Z';LtlL
/,4 __~_ __ .6=__J%YL_':!Ll!!.~-.zz--L~-M.1Y1iJ.L~-<2--2?:-:'t/ /
_~ ____J-Cf.:3.~JPccfgL__.t1~_Qf--j~l{<2-L-----------
~-i~__Jjp.!Lo.LEg!.'[:f9.~--f-Q.U~D~-'-1__LL~1.fR.--_--------- .'
__!JLt-,!J:i!gJ.~-'1E-~.!.i1:!~~-)-~:.::--)-e-~f3~A._5:~~!:J..:'!.!.!..- '111-// I J
1
o
o
*' Name
Address
Phone *'
Signature
---------------------------------------------------------71--~-
I ~ k.t_'U.!.::f.1d.L{J__-"'~'7L.Q,k..f.--Ij.d..;..$Lbr'h'.L-[ti--3.fj..::2D!.t-~;.;.bu~
ILl T .illA.bID_.:;wJ:uaf:l~MkIfl.~_ff]y1e.{i------------- .
/'1 . _ __":d-:~--Lf~~-JlE.tA/)L~----~r---------------- ,
)?r~_~~~~q~_~~---~----------------
)~ D~-~--e--0-2Jj;i!~#r.-R------f!']J!-1Q----------
I~ ~ttuiM-=i6itfuf~jL1It~~~~~~==~=~_==
~,. ?uc._~ . .~.
/0 ~ -~ /JJt.l -- .u?.h..~~..:;;.J:I....--.z~~f!.s:.-----
Jbf _L!~____a1 ~~-L1~--L~7.L~!}i1:!fJ-------------
ts7 _':J:-~.&---:k.~E::!----.:J-':/--Qs:--~~-J3.s,--.-~-~-5-;L:t-QS'
I~ _~J..~~:L_____d).~_~W-~L)..0.CD~D---~~-\.~--
f"aI_~-L--~-------L~-b2.{2~JM~1t~~~--~2~U-----
I.O~~~~------------3~-~~~-------------------c-
IG~~-~st~~2---------~r:f~-~L- _~-----------~------.
I~ __~--~----------j}J-2----JCiLr~~~~--jt~-~~-------
1~3~~~--~~A?~-----------------------~------~-------
)4~_ ~ ~~~~~--------L~-~-~--J.!~-------~-(-:---------
l~'o _~~'='-~~--------LL:i?.L~~~L.G:..-~--
16j?__U!..aLdd~_.Lid:.!:~-----lL2L~~~~~~c.-~~--
1'- 1 ~~~---~~---------['!!.:.J!~!':::.:--r;-fl.:j.~iLJ1.-=-
Jb'(~--~~----------!iJ:~-L~-dA-'L.~-~-8-1iiJLV
lb1 E~~__:2E~~--------LJ.L1~tL{f!_11f~-fiL-1.%J!.~-~--------
170_])1'2L_L(j-~----------'1-?1~)jL~~-M--ifl.--2?:.f.!'.:C
''7 (iJ.J.J~~-tz:--~7'-~~-----L]-~5-J1..tL~-L!!!.1..i:-::~Lg~...JL'?::....l.:t:t..J..---
17 ~_&G;G ... ~~e.,(K~-------.!Lr.2-~-.&-a~-P--::=eLL;!l--
J 7-1~~~~!L::.--.22:.!]--~~~~---~-/3---------
~
1 JljI .w
o
o
# Name Add~ess Phone # Signatu~e
/1i~J:__Js{UJ:-4__~3.LQ:..2..tiD."jh..r::-.__JE..t2-:.11.J-S:..___#"L ~
/~lB_~I5__liR____2.3"Q.::.2J.y.D..A.x.~~--,p!, Z 'S-1ff1c.----------- .
112_ :.-~c)--f}q:.--A.J~-,JZ d' ---------
/1L_ __~------!.J..3-!1--1?~-"-,----S"lf-q2!L~'
111-_ __~~------~2-75:----/2.~ .44$-t:--~,jlrf-l.or ~'-f 110
~~Z=A:~-~~:~-:::~~,~:i-z&~-:%
pI'~ r.. "Il
/f')",__\.....L~-- D...~~_____1..b.1J__.c.;.!1~!l!1J;.1~SL-&:v~,:"-;..---"-~~ ".
/!!-LZ - 4J?~~//7__.$?-clU-_.I!!~~!J1.~~.d.--<-:--~~~-
. f / t.~& '\. .~ ~(L!22~LC
:w,~-~--~"~~~=~-?L~~?tf--$~-~~
/r/?_ll~_~_:kl(2_'t.lM_~k__S.,I&_~2:.~e._________________
;YJ~t1fii~__ljfi.~:m~~$l-</.:'-"-t.L_-----
1f'L_Eh._____fh:etJ,gS'~.:.--j-fj2--~-/2~.k1_---SL--q2.L1:0(;'
,rj_({itil:i,,-011-~~-2Q-fL~ff!:~j.it.~L-~~J)-1.-12::!:LL (:)
/9ZZ U;1~ ~':""1:s---/i!.J.--L~7J:L~-L$J4..Ek-7.J.i.LL-p'
#1-~- t'::!_LL~~~_.sL___9..z':!.(f_-:_~_~
/9#4._1(r;::alfu.__~__.J~~L_m_12l1Y.e_Af___fu'tl_~.1d_2.1C; ) /
1'I3-__~~-'LL~----L~1f---~-!i/!--$/2-~-~~~- 9'~~c>->-_
/'ii_ldi:~~f!;lj_/3*~__c/.L2L!!._d?_~J.:!J_9fJ/-?_t.B.Ah-Ek:,(12~r.d ,."d> '7 ;1.1(0 ~
1,-~_~~-~--~~-r~-~-~--~~-~~J3~-----------
I fJ_4~t,::-__~_~?_O_L_Q~-,_~_L___S_6~_2xS!lJ.S-
/f1__f.:~~~----~1J!..!J!Jf~l:'ZL€:?~SJ!iLp~LI
/'Ie_.1f_'Ul!2JJ':'{J?..__:!.Q!:..!..':._::_.:!...k~f:._F..l.!!.'!,l;Lj~2_":..C.fJ.___~.!::;;.__CLC/J!...=t:-
1'f1-__r!:!:~~t-:e:-___~~!f:~_______._L1:.'Lj2_1jift!;k...:'-----_ZJ!._--.:t..2Jit:?!L-:::'
~-~J-Lt~--~~----------------------------------------
,9.QL__~O~--~"~J-C?-~)J..---------------
:Nl6~~~L(Ed.fl.L--~!ll._-j:t!.:...f1&hL!2-d:..dQ:...-:l2-!:i2L
~
o
o
# Name Address.46' Phone # Si gnatLlre
_ ________~_~f~~~~~-~--~~C--~~~~--------------
_ . . ~..d~_ ~.J32.J/,~~i.tJdJ---..zJ~:;-Z~3l------------
-=__ 'WJi'./L!d ___&l2EA:2.~.d__.Jl:.k~/i2___________
.d/~~,-ECa.____a1!::z.~z,;;z__________
. _ '_t~L?J1Ld1~nL_p2!1.::'_~2;?__________
_ 2-' _ __~___~2_7..~__L~b_l~!:.=-~r-:c____________
__~ &__ ci' __ ___CQ.4J_.!fML?.9SA_J)g_,-_~IivJ~1df:S.______
- --~~~~-~~----- - --------- -
___ ~_ ______~_JL__~_~__i:____________~~____
_~-c.j--~w:::::.-2..x-]-Cj--'1!-!..k-------------fi-=./..b-
-~~----~-----------------------------~
__~_~__________-Ll_2i~-~~----------~-----
__2~_:~-(E~---------./2~.{Lr!.3-~----------~
___~s6J~------jJjI_L..!~:OJt~~------XlIk~.t~--
'-i:Jt.~f)1~~--.;2-1Y./!.~4--o---q.d-'t;:~':?----
~"';:::~L~~~;;>--..)-~~~-5iJl.~~---7d-24,h
'W'J:--6Z,;fQ-------..233.d.--3LP.u/L::L~-~~J4~~LJ- ~'7t:7;ZS
" y1JiJiwd_____~f...~_'fl.~!..__ A~_~::~_~__~:_ __, It
~. _, !/. r...)l~z:.~=-s:::. ~LL::!::;;(./ .
~L _ ~_=_.:?iJ.1.Alf%?_,{:t:b.!.:~'A-:..~ I. . ~---------:-------
" . \ ~~ -
-' ~~--~--~ ~ ~~-----------
_ ' ~_ . __d.f:l~_~__2T~4J_t:.~2.'5.
~~ ~ __.d..z~.li/il..:i?.k-_st~--~rz;--~---2.:::.l..26
. . ___~__i_ZL~__f~t;:::.:.~Ii...._K.I.::_.t.4-c.tj--'7~}-? J.
__ __ _7.!._7AfIb_J~(2-t_>>LE1~Sl:!-::S1lJ__92.!i.jj.~..
. 'I:!f!J;-Z~ J!i - I a &d.-1 .I!:.;...~-!l3 ) b
_~L! _____~~_ - ~~i~~:--~~..~~lt.. ~ - {:> F.JH;
~J_~~__ ~Y~.L:..~_~~,;f::1~_:r.::-_~__J:.________1'
-------------------------------------------------------------------
-------------------------------------------------------------------
II _
o
o
# Name
Addyess
Phc,ne #
SignatLlye
_-/?~________I::tff1)/.4-L.J;I.~'~,< --~J4-::.;IG':J:-----*C:~---
~~.&L....~~JJ_'1..#..uJ.!.._~.J~~""",,.$.....,1,r2.-:1.2S~.:--cz{A'.
. ,# ~
~" n ';,.,j/'_'"{/",,,
-- - ----~r~~~--.--------------------------------
~' ~. -,//.. ,/
-- ' · :!" ~.". ------------a
_ __ _ _ _ ,~ _~~-_:------------gzz.jQ2~ "
-- '..r:.v4w':'jr--Jl~~------------::6-Q'::::~-1::"".C.---;E::.a.::. ""p };C2.... c '-v
~J).>.Y-'JJf,..CY ~ - - o. ,'- .1-1 '
_ __~_ :_~__~~________________________~~t?_~__~~__~_________
:i..,) (Qj" \ , ^ I' ~ CJ2- '1 "2Oi
--~ -~---~----~4:~4-:J------------------~~ ---~-~ ----------
_____~~(J_~__________________________~-~-~-~;QL----
__c:~~-~~~(~~lL------------------~~~2-~-~-~-~-J-----
___.....;;;_' ....(f__L3ti:; - ~_________________S.s1_-:.._~~~-:'~______
, ..' - t, t
--- ~~~---' ---~-------------------~---~~-~~-~~-----
',,~ .;;;-4. Q'))C.. \--: / I
--- -- -- -~--------------------Q~-~---~~r------~-
--Z- L~i~L~LI~&LL_~__________________~~~C2~~~_______
_~ ~LL:__~~_~~~J~____________________~~:?~~~~___~_
___~~~___~~_~L_________________________~________~~~__
___~C~__~~~_________________________~:J~_!)~)_~__
_~~__~~~~__________________________2:z~_~~~~_~__
r- . / f2"./ ,'-
_~-t:.t./1__.f-r:.~~1.j(lC___________________:s.-'d-7.:-J.~;',..~ .2......._
________________~~~~-L---
- ~-----------------~~~~~--
'..i. _kl.['[" __________________________J;E.t.6.::=.!d~!t(::-"-
----- ----~~~-- ~~--~-_:_------~~~=-~-~-~~-
__ClJJlJ..eL.~~lQ:!~}.L~.2!:-S,s---2t~:3L(1L----~
fft~~~~~l~L'~~~ J(~flk
..c..l..a..:.5_J:1~_Q.:U1.P.::jcL--.2i~a--eA_d_C?J:..I------------!l2:..9.r:.:L
_'J".Jl.~f...__t=t___!:.~~-t.j.a..---~-f:!J..a.t.J...-----------S$-2=-Ks:L
~~." _uL__ ___ ____~t~J~.~~Jf.~~L_____.~-~2~L~~~
u: /,." '~ 2..JZ-JI 51" (:J.v.Q iJ ~
(,1/Jf/L.(..-.-JC- V I .', I!:'" (.Z"A.,A n.,u.,-1 7?<67-'3~133C::j
__Uk'
-~~
" . ~~- ,~~ 3 >?'f- .)C- 5" I "77//>-0---- 'T~
P"/AI'I ' c--4 ~; ~~-r':o ~ 3'-1 <<./f~
#- Name Address cs-~, Phone # Signature
.g;g,-,,-~~.n.a:t:.4--1~'QGz-{Q-~1i-.f'k2-::!a_Yk.-
fJ ;f~#_________!~1L_~pl___.sPZ:%2.?_ ~
&1.:L_____________-1$lt____~_~~~~EZ_:._?i~t[ :-- - "~
_:!6ft ___bJ.2~.:e..1:.-[2-~~--4:f/~..2.Jd-e&.21.!.J%. ~
-,,~\a;p,~-J$,2b.."'.1lJ..~.Jjp~-~h-
'Ti'fF.sS-i-E-__t1-:--mY.k.aR..=-L~B.:$--:..2-L-- - -~!iI-~I-!r-l-f-- ' 71JLtlf
ZIJ.1fEty2f!-...Jl-2aL:.~~_/->_.'k$!_~L!_s.t.!.~sa2..LG.
~fA~.k~1{.t.''/''''-~AL~--J4-~~W-..1U~..J.- (;IS'
_:Sff_fld.f.:.€f!1!.________~--#""rK-.2-.! ~______~~_:='~i2. - '.,~,-
---- - ~-~{- - -------~~~~~- ---- - --- ;~
__~_~~;[J!~j;~.!_tY_______L __'Lj_>>-:..?--.!.?!.--~~L'2!!:-.fd{f:Lq-fn-qz.l-j Ii '
_A(Pj.!.\L]}&ZIi!2--jQP2Md~jAAI_.aMla~-9..~~--S1.{16;2-Z~
~~~at?~=~~i~~~'-~ . 7fil','.~"
A' ", ~'I. :z.IJt.tJfL,' ~
:~~---~ - ~-~--~~--~---- -~--~~\~.- -~~~-
~l_ _ _ ___ L4h2JJ_\jJ~l\.nW~---J.~UidT-CA:.-- _ 3, ~
_-:!..!.!!LBJ>.Y1diftjt!J.----1;f.!..iLA!...d.t.d:..--..8.s:vLa&l.MJiJJl,g--C..'3..J-€.Jij
~(jf.51.Y.E.ef.J.j-A).jfJ.!.3j:!:2.ELIJi--SAIJJ5~AJf4~.u'6-ffl-2~tj 1/
_ .lL~-J}.1l.;..lr&3'J~'l1-L..ff25'-zL-zJ.~~t2d~
_L.21J~.wd.l~JL~t.:Ll~-L~J)-~.J..
.!..B!::~_.uL2:tt-2L--~- , ~/)
,$:')J2-::..~-~fIi----Q--- --.L~~ / / .
..- ls.::~!LC..2r.2.'--'~J _~-L I .
__ ':J~ ___~..2---1f2---dp--~--- _'lJ,.,!ilJ .
16'30 ()J :J.t7!1~ ~ ~ -
~~~~ _ ~~~~lQ~~~~ ~dA~~~~~~~c2;124t:~~~~~
_~_1.:f.Y:.~_~~_~'!!!_!!Z______f..i2__f~:1~_____
( 30)
.
, o.G:
.~;~
II
0"
o
# Name Address Phone # Signature
~__~___l~1..o__J.!}..~____~l_.k.1u..____________
_ _ __~..9..Jl.1.5..u-f-g---j.E.51:d.M.L2...0--'--------
-- . ' %-j/j:S'/;-I!d~-Id.:f1"J{--:tJlfltt;(;=r
. .. _ '41!tLl~ijJ~~iMt__3t..Z::lJ.u____
-l#JIf--7..M-~!.---~-:B.-:.-----------.ttJ!.L~-3.------ .
=~=_ -- ~ft~Gi~--=t - ~
______~.o.r-~I6SIQ~--iS..'"1C...I&L~'i.\:~s.1...-~'LY\..I3.e.cA.~------
________~L~~~l~J~-~~!~~~~--------------------
________~~~~~~l_~__~i~~-~~~-~-----------------------
___~-{2~.J.z:J:--.!M--~!':-~-~~~--~-
____~.L--~L1-.f--!.(~-~~E:.Q~-&i---~~..------
==t!-~=-jf~~~-!'-~=~~==~~=
. J . J.. /I / { (f
---~-::<4-tjL~--l,2~7"5;.-:g'I:rJ..-~---~---WO-------V-
-- - ~-~, --~Jl.jrjr~t1---------- - ____~--~~f~~~-O~~
- --- --~~:_-~Jjt -- ---~-~~~ --------~
___ __ ____ _~__ _________ __~-~~. _ ____ __ _~~_ . ;C~
___ ____ __;-_ _____L-5:._11_::t4_d:!.!:51Z_1J!L1!31-____
__ _ ___..L~1-!t_JJL4..~llSZ____Lz.2.~r-.L.t-----
_~~_ __ ___L~LW.:..2.{l5~----{!.Z__tE.ff..J3..----
d~f-~- ____:-_~_~__i2J2k:~.LJ/---~2.~!.L-~.:b-
_~.../)). -I--:$..!/.~_~d(L./;fu..U:--22-Z1-7-)~
--. . --- -~ ---- --- -J-r~~~~~~J-~I:~~]2--.
~___ _ _ . ___ __L5!.L__Id__J;[)______s.i3.:..t::!_;tJ12.::~~
:.-/-ZfJ..,;)--- . -:uL~ uc..:.--~-/-;{.1f.f-
~
,
-
JJI. _
11 _ J
-
0-
o
# Name Address. Phone # ~Signature
~.na'=-S2.~1::::___.ig]lLrA.AJ.~------~:J...-S.l..:L1..------- ~~
__71M.g_.f1L~.f~"?___1:1Jj__fItl._~~_______.iJ_J:~t'1________ ~--~ .
ih.a.&.~-ifu.u:LQL-IO.!Lh--Jo..~-~!:..---k.t:L--~-;{~'l--.:>sL~':!!~
_:d_~!J.n_.Efl~<?___Z~~1._~_~__~~d-:~~.1. ___~
)1L~_~_~~____3~Z_BQ~~~____________________~~ .
_~~~!!.'!.~__f~~':~~!/L.~__i-.z.~-?.IJ--!:.;r,y.Ni..L._Ill2.:A.1.~4__~$~fV<<~
r-~--~-'?.-----j}}-~~J-~:cJl.!iT-!- ~~-)~l~_7.!i~=.!..aL_-;~~
'!t,-~~~~~-.,L~LL!! - ~ _______r@..~K~__~-~.p,,~(,-...~)
~~_ ~1)3.. ~~!~;~ - -
~:iJ101J -- aj..5.:LJ.t..._______~______ ----------- -- id-:57)'f
____6..L~_~-----..fL{.z--~-fL#4--&--f!::t..J'l-J;2. ~
___mq..tllJ~---------~(P-Ce..!-.3.--~G3.-gtk~!?--~~~~nJIKl-JAJ ra-r-
___ _ _ _~~---Q..!9--~-A=-4b--~-UAPd
__ < ~----'..lJ..jdS~~~T~'.I{?;~ ----
__ ~z~s6....~-,--~---i:?-2LJ1/....e?:..L~--'fJ2~2ffj--~L.et..~~
#_~----~2J...'L/}." .~~~~- ---~- \
_ R.._J..J.JJ.dl_j..il~.w~ _ _ . _f2J3._3111../...._'l~~_ ('~
-~-~-7Z=__--'2:-i~__i~-t~----~~~;~;;z-:;J~;dd.
.. ~-----------~-~-----~-------~~~---------~~--
__~ __il.. ~~..t-=-E~~~..!lL__~-=..Ji_C[~~Q..(L1J.~~~
__j2'.L:'-~-~:...:.~~!2..r%'.L%..u-a..~~
.. d___ilJe..Q_..u2:.&J;..__k_s:..I3..__!Sl:L=Ms.:L-M .
_!5JIL 7$-~f~~'t~-11!.:.iJ~~-~-- .
--~gJD-~-- _bs.-~x....a_9~_1~_~_i~lf.~~~__
~____~lJL~-,'-!t--~tb:..~!r.2:):'-lL
~ ':n AA) f JJL ~"' ""'A,/; .Y~. Q ..--=::: ' ~....: ~ -
_JJ~ ~JL~_______~~_ ~~_ M _________ ~1~
.. 1d..iA.:;q(.h- . .L~3-2~..Ia~d:--5~-'Ij'g~2LL-_~~
~~ .~~
_ - r-~--?.3?-~-~~ -- 'C4
-
- ~
]
.
JI
0- 0
*" N/f.e fl J IJ/) Address .' / /} Ph'j'"elf . Signature,
~__JkOb1QL __LjMJt2.-_iJ:JS:.1LJl ~LlfJA1iL/JjhLb1:.?iJf-L{ui!l.!fy (1ft1W~:
__..Ld3_L~'L :tui.-ilitL,--1:.tQ'::.1e.rj).QI!.:L~Z:-
.t_ __~fl:t_k(__L ---;:k~:.t---~?).z-k:L.z2r~' /
_1:!:!d-_____:.0!..'-.:.~_fJr.~.r__!L'__{i::Y~H~--&J2L if f/ '"
_. 2!-s..~-=-(f.f2~49:-./tI~~-k~r~!2.f'f/P>Y;7f?10
___ t/.~_'.U~_~~.b:k;}tj;&_h.i:J4.IiP_./ltl--7jjL~lY:16'J67 .
~LL- _~~-.:2-A!f.-~.--~--J!y-:..~L-~~~-~--f:!~Lf' 1f1Ss-.
_ _~.:i.4'}JN/~-..I#J..&.L~. --../DJ~?~..
A.~~lkwe.~~ __W!P:J5S_ - ~.~
~.ar;!ft ;-1-/ LL_?1.3.(pj..EL'-J!:~f2.Qtf~/d:z.' - I .
-~___J!~____~~ltL~-;;L:.. 'tl.__.:.1J.l2:LJLb.__1
_.';.'.1"
-------------------------------------------------------------------
------------------------------------------------~------------------
-------------------------------------------------------------------
---------------------------------------.---------------------------
----------------------------------------------------------------~--
;\
'.;\
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
----------------------------~--------------------------------------
~
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
"'
:~
";:.fi
c.+Jl.
-
t:.
.
o 0
# N e Address Phone # Signature
~/ ;.~ ~~~__2{!/~75.i;f:.--;lL-<2f_Ld-,j5.L-aj
_ ~~~~Li~~JEi---------------------------------
-~, ~--~~--~~~- ----~---------------------,--------------
Vhd / l".., // f;' ~ ' '/~. , c,'
..0'..f'4: :.tZi~L_.!..4"~ - -- -L.~-M.'7t1f:fb!~L~.t.-~4..L4.;U1 ,
----, - - ././J..Y--- "'-~~;&r~-~
-"-"--- . ~~~~~~~
____ ,_0_:. _ __~~.I2t;:'td!.-::!."2b5-e-&j~J..-i!..t?::!.fL2~f:-P5f,
11 )', 7- 1 n ~~':;.1LL_L:k3.f_1!J.."-.1.Lr.!:::__f1.__j).:.fi__LtJ__2.~'i.LL
_~. __ ~:.:.~~.:.~d.t::L~..:itfl.l.:..-l-~!g....i-4!i t/t.
., _ _, \k~_r)L2LJ_Ll.:..:l;~-rf.,-tL~22.:LLL-
, / .' f/..'1~~-S2Z[1!:....----~-~~-.gj-[g1f!.jt
- -- --z-'_-:'~_~.J'L~&:'~ . ;d.~-<i/I
__/ P7Jd: 2J _ ~,~/!AZ1.___/%d~i!..~~~ _;.?tZ-.2~2:iL
__ . ',' ,.' _~_~!2L2 'si:::..5:LL.2.;ail.L_
-14, ,~,f.QIt1--l:~, ~ _~,-e..t:::,-----,!S:fl,L::.-J/, -"_(['-i'.;LL("L_I~____.2.=-a_, 2~:...{.!..~__
'/. ,. f. -,." W 1.// T...., 1:1, ,.., ("' i( ') ,,,...
-J'::_'2;d___' ~.L...e:.=;Z___-l.u.~j__________-'-'-"'..l..______,-,_.e._:.~x.g..4___
~& "... N ..,,4 .s..'" 2
,,+- ',' '/',',., 1 , ",1
- ,--,~rt:~~i::------~----~----~-------- ~~_-Z~____ ---
______~__-;:7i}~n~---d2~f.-~'-d.:..J-:.{L-:d.------J:f-5-~12J--(L~-~7.Le.
~~2LzJ:y:.I}:~--~Q~-s.-k...~..L.==..s~---~-~.ft.tL-
Jt-~B~___!l2:!t.~bil}.kl.~2_1t:__ut:.._,:.JL.r;;.__s....c...zS> y } y ~?
tV ..~ !.....~,"? / ffi""'A ~ S:..t. fl:~
J1/t II' ,,1 ?' " 'II 'iX tr ",,;' . <:-
"--'l~2 ~'-____t~---_-,-_ ,~a, --- -- :!:.O..,J -
. /~90
--- - -r- - -----c------------------------------------
____~-Q/,1. ____J!......:fJ:_(..~!,{L__2__22_~7d~~_i..d3_:._'?.E.!!.q_'?.
____~I:~~~-~~----/./.~-'.J!'%~,t:-).L!~-------
-mlJ.u.;..t2.i.'l:1.MJ.J----Q.l'J..M~---2-Q..ef-..I:1..-~-'2..!J:.f:1.L~t~D.fL 9 z. "/
_ ,,~1J4~4_J~~2-_-l-~&~--#jt2L(P,..l--Si~--
~ " ~y1:1;V~L-----T----J'!:-3.~----fl-=-~~E.-~-~!:---~?:(i "C-
__eJ!(.!:~l!lfj_~__________::2!LIf_<P._JJ...,_..si~J..._r.__:i.:..__l2i_~f:.
cJ
-
o
o
1* Name
Address
F'he,ne #
SignatLlre
-------------------------------------------------------------------
)03 _:2'22uc.J:...LlL~.J---d2-Q.:..6.0~..I.t2!2.-l.cffi~L..(!:~--'2--?i:..?y
j04 __ 4:l <UJ~ ____.1. _L{ff:.-'v_aL~~JI.__'::i.~~'2___'i:..d. 7l ( /
o~ / . . . rj-Lf 111 ICtJ.' J 0? _J 01;21../0 ,-
" 1.L_ /.d4(' ___-1. ____I4.i..L_ l.ffi~11 -:_~7~___ ~
.'X> ~ _~ ~ __ _____ _ ____J~-::L~~-L~.:L-- ______ l~~_~ <{ 17' Y I{
107 _ ___ __ ~~----'!-fQQ.--J2----~-f~-i~------
20 eO.' _ ___ _________~____c;LJ_<L.._0!..__"2___LjJt~_J..LJl_{j'_ i ~ i( / (
)O~ _~--~-----~J-~-~--:e~~Q-:----~~~~~~----------
;: ~ -~~~-~~~--~~~7.6--------
],,, j?, ff-~~:::-::=:::~~~j*~p--~~~;~-::j!~;;~I/
1\3 - t lU[(_~_l/~-----~~~-~~-, J_~___tl~___d__~--------
QI~ __~~------------------------------------------
~J~ ___________ _~~~~_~_~___1~~__~~___________
.1' ___ K' __.:__J_"L73___0!-jZj~:_ _ _~_'!P_L ~ 0
~ r. __ . J:!_ _ ____~~2i?:i._lf_ti~~~ ____ Gt~_6r-
I'').' _ :c.:n.~ _ Q________J;2!1_~-Yd-.--k.~:..;.. __ _~'7;111
~(9 __~-- . - __:b~tl_ !7.A.JJ'A:e-id..~__~_&~__7LL/r:;
~: -:L~?!!.. r:4------------------~----r;;.l-;F-----~-~-:-------~ V //
_ _ _LJ&.______I5.fZMf.rad!_Ji______SauJ31'lL(L__~_
XU ; dih..I..;_::22U~1.....___(f2Zb.t:i~1~.s/:.!!.6-~-f~-1ji-
123 _~_~.,/ ------~~C'J.<!.!.?(-;!_-rf~-;-():!."'2"'" II
!:1:J.Lf;j;izt.::ff:.cL?;2 ___ ______jSZjr;Jd~ L~J~_:RP.:'..~fJ ~
,~':) / L 'L~/': /s<:;.7f If/'~ I'Sr- SA-vv 6/Vdo yz</os;,-
~ ----------------------------------------------------------
~~(, __1::..-~ld..];l,.:.::.--m~----L;3-~~---~e..t?..d.h~tt~-L-----------
~7 /1J..,.... . Z;Z pi' . 7
--s~-ad?~~-.-a-:--.A~:.-----
:f.G 8 _ ~~______~q.l...~s:JiMki1.~~--;2-!.8<------
~~'f _. . ..L'!..A.._~-----------~-----------------------
1.3v, ;J __ . _______ ~___________iJ.l~___l1...--~k-:D..--------------
"
o
o
# Name ,Address Phone # ~
~ . ',) ',_, /, ,'C -::- .1', .}, c ,n, \ c.,
t-l/~.,I i . <J')~l "(!i,"'" i"'" " ;. -".{ ,t::.)l.l ( ,,;,7, "'k'.-'.11~h'" l/.:..
___ . :::::r..._~________'_"";_______''''''______________..J.________________----~-- ~. " .
~..; '" ""
~""~~." 'f--..::2..~.u.t--ts..<;J~-;!_., "'Z~_.c.-::.:.~____~-&-.....asL__"72i/ I)
~~~__~1L1L~_~~~:L__~~_____~~~___~~~_~_____________
__', /', A '_~, ' ..JJ~7--'I=d--./J.,' _~_ , ,-.Jr1.._-..s.,()--9-~~5
'~ . 111 /);A~,~-;;:--T;'#, /, ' I,
--- 0.!ff..Jl- ,'d'W~---ljj-L-1$:df>>'~- I J~~J:ti3..~j!jf
-m?-r:, ~JM';~ --0-~~ ..~~~?).'"
_'J{~t~__u.)}.jJ.._U~~;.___~_'-I_~~%[Ld.JJ.~4'_]!5 -
J2.d.'; " t/4 ~ ~~~'l ~.d:cP- ~
___;:j -"i ",__!... ~ ,~__~ 7'-~ - ,-L - J______
_~~~~ ....'&______~~___~__~J.___________________
__~J.d1Q;;.~---~JZ:-::::&--~-.2.~~---~;!-'1-.d--~.:~-~:t~~ _
___~~!:&'2bJ_____,.;tdL~-~-::u----~2G-l----ILC1....~--~{--s.'-~--t)-:!' 0 J
_.J)_~_l _7' -_~j':5:A.---L11:1JJ..B.iL!:I..-~-.R~---~ 3e-$~2t/)
-d/.o. -~ v, ' (7
.~~-V"-~ ~-...2.j.l!i.~~---...J.llC--------------
_~~_r<:_ _ ___q>~l~L~~___~B..L.c&~tJi5LQL_______
, -1f~---~~t{)--~t~~i~]S-lfl'-c.A:-:t7..JfLI
_ __ _~---~~~-n2---- --__ --- -----~----~~~~
_fj2/.A,L_Sd~_.!.-~:-:Y:~~___~~L~~ait;!;L_cL!~.Lg
S~i~c,lt--Q.~~:""'~QZ----3.?-?;"--~~~-~--~~------':~?:..~LLQ
J:.J._j.!.L.':;'';,Li..Jl ~~~__.lJ_'i.u:.~~.!g~__4':'LR___':t.'-=:t.Q~ /
, , )r!}c
" I t' '~
... . ~ . ., - .........~.t.~1 .,' .> __ .
c;"...,.i , .:r,' r""~." .,i " i. '\'",... t.-..'lt.......~1 .'
f~t:..".u..---."..~-c.:S---------L'--.,..;;.-"'lL...;,;.x;.J..--"---..1...llU,,$O-~ ,
~,~,,' " ;2/iC, :'~:._~UL~~_,.J,.l ~"e_ _/I/{t.(~~~~c
/(t'..;..~~ i "-' .. ~ ~ A~ 'J1 C -I lIO;:::;
/. ___~~__ ... -- _./Jl:..._ - ~- - 7 ~
,./ /
~tI. - \, ----------;6d ---- F:.----------::'---,
_ _ ________~___ rfi~_~!'..gL_~_~ ~
~ _______ ______~~_____~L~q__~~__~~~_~~____~~___
?}q~ PJJ:?{i~I4JJj~~~Cp__.Lf;_~_Z_g__~L~_~!__~'?_~:;~ if/I
,:Jf..~_:'.!..2__jJ.!:.LL~f:.,,"_:.___L~Xl~~__~.L!:?:..,--Jt:!..:.-!__I.~_?--) 9"/('
./ u
J
)
~
# Name Address Phone # ~~~~~
.d"5.~~~jL__€[::!/.l~:L______--
&_ _~~~___...Lt"L.I.!J.~;1i.~-~~--.li.i-.=~fg--------------
~~J&~_.-::1141._~,--j~-:--'l.~~___~~:J!:-----__----_--
f',.~. ~-~ . ~.' '') -- -- 1J:JJiLf,-flL1LJ:if-".,S.Ll.-c--:f.:.fft::2u:L-------------
~-~~~_~~~e~-~~~~~----~----------------------
_4..!~___Ll?_~__,/~~L!!d-~..:L-2.~::z.~~
___~~_(~~______~j?J!~~~------~~~11~~-~j}
-tfj; ~f...[.~"~----1YP ~<1
_ - __~___~t!sfil1.., ~ ~ ~________ff~~:z.~_'L
o
o
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-----------------------------------------------~-------------------
-------------------------------------------------------------------
---~---------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
.J. J..
-
o
o
NAME
ADDRESS
PHONE#
SIGNATURE
fI ~~
..,
"
f'i;
, ~
//7~ ~~~.;:v ,
a/~ ~ (~
/ J /~ ,11/ h. ....,. 5, Lf' c/<- '.2
/s5-)) ~~/ c?7%- 1'::; y /2)
7/:7 ('~O!~ Y:z.Y/ll
s~
.
-
lIIl1 ..L.
-
o
o
.'
.
.. Name
Address
Phone ..
Signature
-------------------------------------------------------------------
-------------------------------------------------------------------
~ - ---'---~:-----~~~<~
JJl.UeZ---l!lfi.~-_~~ -F--d:...2L~------ ~; I!(u~
r;-~L:iJ.21Yd2e:t:;c~_.Jt.L~-'14!---~( (' t1
_ __J5:~~__~~_2.~~{___:?_.;_~~___ c; ..
~ '~~
_ d2t29fi"..iE_ __ _ _~,-_---c...
_ '__ - -- --- ----- ~ - -- - ~l?<# ~-o arr
__ ~~~/t___ ~ ~~.
/ , ~r(/~c' A/1/'d~--y__ " '"
-- ------------------- --------------~------------------------
, , ,(J - ' ~ ~" 0 t3 Cat'
_~, _~___~---- _.;._______~.:j.3...:-uJ-:..-.L~--.=.-.D=J.:--.a.;. ,
__' 1-~-fL '____2.:j~.:__td:..__L,:f_~_~~__t3. Cl' '.
'/1 _ ,', L<I ~ /? c ;~' 1...1... ? J4 ~. r
--~--~------ - - ~-- -~-5----C_--/7~,~~--~().L
_~"---d--1$-~-------~~-------:.:---:~---~~-----.: I /I
, ____32'!1::e__B.m~jJ+Q~I3~-;'-2-~ LfD S-
___.flof:2__~-fu-~-<-~
i;L~-+4-7-(l~-~.1i.;?; ~.i:,?",1;z.j)2;;t"lC'Y Qy
~"~ ~/O~/ C ~-
- - ~ ~~':.il._ - ';'j",.> '?
_ '___jdJ'jLJ.J.:..~~-- _ ':l@~LI1. 9~Y;
- ~~.l..J.J&/;ltjkJ!!:f.l--~- __ -~~rt& cpy /1
______ . _j]~.-L:?_.2-.L-~-~f!J-~~-+M 9a2f,1ll
1+hJ--L~-~-i.~L0-;..j-L-.:i:lU r- - '1~~e.t!1..9<>YI/',
..,/ ' __ _~---~~..L2-~../t:~---_Jt.J-~---f-~-t..?- V If
~oO~ f'.s-~7tv:;~! t'et.~ff:: ,S Ii q2u/( P-it.FPi?-.>,,<j'
_ __________________________f____________~_____~__~___~
'u~/4_"t.:-fStf.i~;.e.1-qft.J!.eeMl!.:i.!.t.~.J/44..c#<--~~V'O~
'~.e.A....~Aj ~ '_ __ _~~J-'i-~- rQ!..____'t~_~S
- - ~
o' 0
,
.. Name
Address
Phone ..
Signature
1 -
'.
o 0
,
.. Name
Address
Phone ..
Signature
-------------------------------------------------------------------
-it.~--- . __IQ~.2_:.~.:_.Dl.l'.v.r..___s.~+c..jlL<.:1.2::Lto ~
- _____ __ ______3a:2?...._g~b~4:8.____~k._CA':ZW~
-".f ,.~ ,,:q---Yd-~--Q-~J:.K-JJ..,-1I1W~..-.,J.~~
~~1t~~~:J~~-~.R:"
_ _ _ _ _________1:_~_______~__~L~___~-~--~l
_~\Q:..:B.~\4.d------~~~-~:.t10I!'~----~----~~:f.Q~-
_.fl;1/T u..~_____.a.~.1.a...71.._~_~.dB_________g~---
=- __ __'J14~.L (J ~ (2--..LPPS~l-;.d."-~Sr--....Jta-2i1....yl
~_ _" W_LJ1Lt:;.J:ti..!2_____.l~9.12B1?P_aJJ2...-?f3--92.Lf (/
...~~Jh_~~_.J.t.?_S_i-1:lia.. _~_~~__q.:;)tiJ',:
~_~.J _ _ ;:-__ ____PJ~'-1.__..I11P &_S~__Z;2y7 f .'
~ _ 1~ '. 'SA~_.2~fOI( .
;?~g ,~ .. ' :i::S.:.___?.;Z~/L
____~------&6?-..&P~/.;c /1 j, ~~<.:t.'-L___
_ __ _~~----L':J-=:i--V-L4JL!!.U!;-:i-~'.::Ljl-------
~' . - -~4r_~d~3::'--;!!2L-!1ff~_!fC~!.:.~J3:.--f~-~!:?.~~~
~n--~~-~~-~~~"Y
__~~-------~----------~---~--~---~-~-~---:z~ (
_Jl~JILlk~/.J;jj,.:J.IS:..___gJiL_'_Y~_3..Y::..t\j_:S_l.___~_m~~
~'l:o:-G.JJ.e..c.c.e.r.:~J:f.---3-n--\6L2}t!i:L-~t--~~ r'
. ~Jl1.r~________J2J1-2!!~--1?~"-!k--~~-~~--
- 4-~-LZP-irf~-Si~-:f~Rt:LIY. - '~"-S...~~'2~-~~~
---- ---~-~--------------- -----------------------~-~
_~. ~____11~. 2?_~J:.--1L----~~-~------s..jLtjl.-f-:i
/Y- " il'" c;,
_ \ _ _422.L~__~-~~'!:_3--L.5..3-~:k!../.JtL.tU:t.-s...L-:----2.:j.//
-------------------------------------------------------------------
-------------------------------------------------------------------
.-------------------------------------------------------------------
., ..
. ,
'\"
Q Q
Address . Phone * Signature
. __J.$:&flt/L{'i€._~~....__'2Ltfm.:Jf2;"-~ #~
~ & -!!/dYJ..~J!lYldJJ:---2j~:5ii:!lLLL . .
- -- - . ...----.I$1Il.J.t!.!;t!Ar~-r.._;:.-':..-~------ . - ~~
~~-<Jp ~-L-S'A4~~.t.d:-f..h.Hv-yt:.~ l~fL
~,{id'-i!!!:ll&..~~___&_:'!:.fl!~~~~~.l!1f!Z!l.t.__________________ y .
~_W~_~:!.t.!._!f.._ _____.:__ __________!:.!..Z~ <. ir~t
_!f~qf~~-.ui--ZJ{~~---~.%.f:L~i!.3.L--c.k~~
~--~jf!~:.::> ~~ _M_.L~..&~01!l---~I!=--$.i:..z-~~-~-Q------. ,B..
-iZl7rLI::1.~_-.___~~S/i;._La~_~12.___Jk~_$..lf.2__~~~NJ ~
- . -~~-------------~-------------------- ------- .
f!j__1.!L~__S32~t)tCIJD..ti__:s...p~3f:J:j9_1l _'dt-
_______~L~--~!!:.J..!::..!!-~~~-.2-ft--- _' !..!_iii(.C7( .. .
_lJh...J_~__~~_.Q_~~_../J21E~-L~~<i_____-:________ ___R~lL fl\Jljrt1, .'
_~;1fI'--d_~--1~"'L~_~~c~~ ..
_~ _ r-*~;l6J~-~- ,,_t8lt:-!!S1._______ .
__~Uj/~. __ . .___l2.~i/_:r:::?L~--~-~;.-2-;l.,.:z/L----.-- .
il'llf~Ltdt.i.LJ. _t~~tJjb_~~.JtL~/~------------- .
~..& _~'-/ __3..::LELN.~&_~__S1l:__'1.1:::._lJ.LfL:.____
_~~.Lf'-_________L_J:.~~_~.!.1~7;;i_tci.j!.LL_____
. __~~__:Il~..L:z.~~-=.PP-.b7~.:5.f:.----fj~~,#-S.-~-
$~'f~~I-5t~c;2Y//
. "---.......-/J..A.4. 'Y71~ '--r~ . /D <1a.. tW /1 Sf. ~6. 9:2 ',L/O
~-::~2~~~~j:;:~~.
- -"E7-~---_21~~i:Z--;-9-);Ii0 ,,;
. __ _~ \./~~~~'--------~~ U4'4'..7- ~ .
~' ~C:-e/ ~~ ~
. --- - - --- -~ 11--. ----------=-1(--V--------#-;-~7l-9J- y/,---- ..
.__ _ _ _ _ ~!-~----~~_L:i:_--------------ZZ----
. .
J..~.
-.
o
o
.. Name
Address
Phone It
Signature
D~~~~~9~~~:~~~1~~~~~Z~~;~~~~~~~=D~~
-~jJ~t--E~-~~r,--JiTQ;:3-~-
--- ____L~~JJ~~.!Lt.02----Ki1.::.o.~K~--
LtJ;t.!iiLzi2_ ':4~tt.tJi..t.J.J.U~..Cls..JL"LeA;5t_112L'i.{.$..
bU "'t-i..t.q,.- aJ.:!...c.5...a:~_J:J..2l~._JtL~S:L_S.!pf2.s.-i:-'Jsr..
-' :./1ttJIJt7t14.b--~I6:-- - - - ~--
J)~jlqLd..j._.!_6J)p"-'~__fg.P-5€~3..~~$:t._1d. __'i__~_____ _!.. CiAV
.1.!f1~-<;i#l9fJ---------.2.~-'a-~A.s:ti.1H-G.Ts.;;Cl~..1t.."-c...:.:t2f1/1 .
.' ~-.df2.~---------~5!.J::..-{{J...-1.a.::.-~./:--~-t3.-2-!l..-Jz'.f2;?
'. jj)!~J1__jJuG:Y.Ltrll.~Ji..----:!::..!.i:.t~!~--d-~-~!.L-{.ti.-.f.?.:::.'!~::.---------
. -.21-~~~~---~ ! -'2(:- ~~. ~/ e{ ~ ':.L---:;-.-~--;--:;
_\=~__~~:.J> oat ~_JQ~..d,-_.u.J..~_k_.!~..!~.L~__ 4 z-..'i_!.L
/(A:.At( //" L? fA ! /, D.... . .
;jj!~-~~-~:~~;;:'--7rfi.-----/---------"---~-~:=~;:---;--9i~;~;~J ~ ~ '
_'J!4J.J..t.J,.._:::'_-~2.:.~----f:.?-1-.AL!-IJIL-:ZY;-.--------,-~'e- pi ~
__~__~_.i2_!L__f.l2_______~
._~~~_~~Bd~-J.t-{;._5hL.__________ -
I"':?J L.w.. .LLJ qll.~ ...af.. 4. 1/ ~ <:a.
....::-____i.-il--J~- -..J-f.cJr.~"'~""""" ---..........~7-- -
~_L~i}LJd.:._dtf.~~_ J:L_~~;!.f.~C:#
-------------------------------------------------------------------
,-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
.
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
.-------------------------------------------------------------------