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~ ~ <br />(I/We) do hereby swear under penalty of perjury that the <br />foregoing statements are true and correct. <br />Date App icant <br />SUBSCRIBED AND SWORN to before me this <br />(Notary Seal) <br />ajh.118 <br />day of , <br />Notary Pub is in an or the State of <br />My Commission Expires: <br />14 <br />