roperty taken from me ale Mai I have received a cod/ of Old MCORI. I hereby acknowledge that the Move MI eepresenls NI property Imigeonded by me m the WON DertcomenM el my duly &gamic. other. c LI) . i, L.i II SIGNATURE DATE SIGNATURE IDS UNIT RECEIVED BY REASON DATEMIAE RECEIVED k sir 60 03-17-or 0700 C '. g 1,2r