vidual 0 2 Partnership 0 3. Corporation oyac Co-owner 0 5 Eimet. 0 8. N°^4171thre" NAME OF APPUCANT (Person(s) shown on evidence of ownership. tf Individual. isve__ name. NM name: and middle Initial) 1. Samair, inc_ WN . ING e l do address below an undivided 6.25% interest 2.- See Attachment