s, ? ea, a _--( CF.- I SERVED DATE 0 876ild, PLACE 00fre-1- / a_ ((Joel //I'M' ) SERVED ON (NAME) Colo &It sl L_ (Ra....L.IC (4-7,..;4. 4 Liffe r) SERV; TITLE 1-8 I .5 --7 c:f..42- 4 -8--e-if — STATEMENT OF SERVICE FEES TRAVEL SERVICES TOTAL DECLARATION OF SERVICE2 I declare under pena