2-l<> y 2,.\) '1 2~3'7 7.::-<{(? ? ,_ <O -/ ] .. ' 6) 7)J1 J}ctt? t.pl.J~ <;;1 1/-!ff 'f !<fv t;o9 Jtv1 (~1>1 S~<f;;J (:01 --C !t.., o~st b:}f/ )~;Jt ] ~?1 \l~)<J} <::f ~Ct:; 7 b)(6); (b)(7)(C) SIGNATURE (b)(6); (b)(7)(C) I MCCNEWYORK SPECIAL HOUSING UNIT 30 MINUTE CHECK SHEET ZA