LICATION MUST BE SIGNED IN INK. O OF REGISTRATION (Check one box) n. C O 1. IndhfidUal C) 2. Partnership (2s 3. CorpOratiOn CI 4. Co-owner ID S. Gov't. p 8. /44°"" zen Corporation R NAME OF APPLICANT (Person(*) shown on evidence of ownership. It Individual. give last name. first name. and middle