a ATTENTION? Reed the following statement before signing this application. This portion MUST be completed. A Nye or Obtchtel ins WV tbAISSOA II MS •Qpiatte y tie QtviVfil /V NM/W. by NOard OF rwsorwent Ei Cade. Teo 18. Sac. KO! 1 CERTIFICATION NYE crAnry IN Tel es saw was s ,.ad by b, assayed sisican