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128
A-3.4
Respectfully submitte
By baw We Vim 397 Wh, tL by MY arbors NY 03254
fires iden: ¢ Treas uyerr Oofop Cr : j, A/T
_— ° Being duly sworn, deposes and says that he is
Padene. M. trite
President +Te Fede: Vis, Enc: ELE
rts, dent + [reese of CGrical Tastuilohons, pre- ELT
(Name of Organization)
and that the answers to the foregoing questions and all statements contained therein are true and
correct.
Sworn to before me this or day of Oe ber 20 7
MICHELE F. NEAR, Notary Publidvowary Pubiie
oo, . My Commission Expires August 14, 2018
My commission expires
(Seal - If BID is by Corporation)
ATTEST: OL 7a V. ffs # ASSO Secy
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