ard) I am requesting a E reduction rgwaiver in fees and charges Specify reasons) for claiming exemption: Hen Laid C.e.Re CFI R D - Q NeM Pga__ NA Nit & SIGNA FURE OF APPLICANT (Sign in presence of a member of s \ P O L. id01,0 I( re • 0 1 / 0 -9 204 0- ____PLEcaRC-L*_____..-. _-(- (Family Name) (WINN (