or Designs, Inc. Account #: Reference: 1.53- Inv# 157178-Final I itiatties Name & Ext Stamp Initiator's Signature Authorizers Namc & Ext Stamp Authonzer's Signature Chair/Caller Name: ,a-rtv &cMet-- , Client Telephone: 41 io i at& `/.—HW eg.iig..-5/v.j i C Call Back Name JAN YOUNG Call Back

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