penalties of paltry. I declare that I have examined the election including accompanying schedules and statements. and to the best of my knowledge and tele& it is true. cavect, and complete. Signature of officer Title Date For Paperwork Reduction Act Notice, see separate Instructions. Cat. No. 18629

r penalties of penury. I declare that I have examined the election nduding accompanying schedules and statements. and to the best of my Imathedge and tele& it is sue. correct and ccaptete. Signature of officer Title Date For Paperwork Reduction Act Notice. see separate Instructions. Cat. No. 18629R