LY TYPE OF REGI (Cheek One box) I al i IndhildUell 02. Partnership R:r3. 0 4. Co-Owner 0 5. Government •i 0 S. NoreCitizen Corporation 0 9. Non-Citizen Corporation Co-Owner NAME OR APPUCANT (Person(s) entran on enacts of eminent*. II Individuals give tan name. Oro name. end middle initial.) II 4 e I i Leo LL

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