provisoes of Seneca 14-i ID and 53.4.151b of the General Slandos I undoestand that if I make a statementwlvcb I do not believe be True. TAM PIM b WNW Die Calumniator. I era to autoci to proseculiOn under the abovitnoesO laws / \‘,. ../. TATE A I Al—, A/i713 i4 V- C(..., DATE SIGNED CO-OWNER'S SIGNATURE