t for 1,2,3,4,5,6 Date: By signing above. the applicant agrees and stipulates (I) lo the terms. conditions and certification 01 the AC Form 8050-1 Mash Registration Application. to which Mrs page is attached (the *Applicabon"). (II) that all of the information sot forth on the Application is true and cured as of this date,

9.10.11.12 amen Nerman 4-tq-os 8y signing above. the *pecan agrees and stipulates (I) lo the tame, conditons and codification of the AC Form 8050-1 Mash Registration Application. to which this page is abashed (the 'Application". (II) that all of the information set Iona on ow Application Is true and aired as of ads date, and