Under ponallios of pcshay, I declare that I have examined this return Ond atteornaanying tioctiMente, and, to the hest of my km:Wedge and bolbf, they Pro rue, ' correct, and complete. FILE COPY / 'Signature ra • TItle paani DENT Date a- 4 • -,70 / ( Instructions Purpose of form. Use this for