f3 • /t7 0164,j ,hekio- i•fif. jive° Af- a • 6/24....s ) )7- < lot > SWORN AND SUEISCP : • BEFORE ME I I 6 rc SIGNATURE OF ARP TiNG. VESTIGATI OFFICER / msa.A NOTA • ' RLIC i—r• OF COUP ICE- OFFICER 40 --C). 4, NAME OF OFFICE (PLEAS RINE PAGE DATE io'4- C., j /WI ,