PROPER FOR PAYMENT 42a. RECEIVED BY (Print) 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42b. RECEIVED AT (Location) 42c. DATE RECO (YY/MMOD) 420. TOTAL CONTAINERS STANDARD FORM 1449 (REV. 21012) BACK EFTA00071882 15JA5421F00000068 Page 3 of 9 Table of Contents Section Description