eigpa ,t4. R ea...et ,..__ SERVED ' DATE09/167cc PLACE u es(pa s...:R .cat i . te-rs SERVED ON (NAME) b3 " SERVEC TITLE Fa I S.izie_Lc„:-Q, Al ta STATEMENT OF SERVICE FEES TRAVEL SERVICES TOTAL b6 b7C DECLARATION OF SERVICE2 I declare under penalty of perjury under the laws of the United St