USE ONLY 5-I PURCHASER NAME AND ADDRESS (IF INDIVIDUAL(S). GIVE LAST NAME, FIRST NAME, AND MIDDLE INITIAL) OWNING an undivided 25.00% Interest Michels Pi eline Construction, Inc. tc ita, 7201 DEALER CERTIFICATE NUMBER AND T'7 L13 SLA.C1.43 C3 WARRANTS THE TITLE THEREOF. CSIERWVOMMUMNISTIDIerents, AND ASSIGNS TO HAVE AN