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HomeMy WebLinkAbout410s Statement of Or 4V5 WHERE TO FILE: STATEMENT OF ORGANIZATION T Date Stamp Recipient Committee File original and one copy of this loan with: Tlir'r . Secretary of State fiEC IVED AND FILED (G §�ernment Code Sections 84101 84103) Political Reform Division In the Vice of the Secrets Of State For Official Use onl P.O. Box 1467 Secretary y Amendment Sacramento. CA95812 -1467 t the State of California Type rint in ink 0 Check box if an Amendment And, if applicable, file one copy of this form with: SEP 1 C 199,1 YP P and enter I.D. number: The city or county officer, if any, who receives the -- .942505 committee's original campaign disclosure Act TY MILLER SEE INSTRUCTIONS ON REVERSE N statements. 9 Secretary of State I Committee Information II Treasurer and Other Principal Officers Date Qualified as NAME OF TREASURER Committee (11MI, D.y. Y,.,) 9-9 -94 ❑ Check box if not yet qualified �• NAME OF COMMITTEE MAILING ADDRESS Committee To Re —Elect Ron Parks I CITY STATE ZIPCODE AREA CODE /DAYTIME PHONE ADDRESS OF COMMITTEE (NOT P.O. BOX) NO. AND STREET NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S) CITY STATE ZIP CODE AREA CODE /PHONE NUMBER MAILING ADDRESS COUNTY OF DOMICILE COUNTY WHERE COMMITTEE Is ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE I AREA CODE/ PHONE NUMBER Artach additional information on appropriately labeled continuation sheets. �III Disposition Of Surplus Funds You must specify what disposition will be made of leftover campaign funds, if any, At termination. IV Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information c nt ined herein is and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 9 -12 -94 At Perris, CA B ✓ �� Joseph J. lZuebler DAIS CITY AND STATE IGNATURE OF TREASURER Executed on 9 -12 - At Perris, CA By Parks DATE CITYANDSTATE SIG TUREO NTROLLING OFFICEHOLDER. CANDIDATE. OR STATE M EASUREPROPONENT Executed on At By DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT Executed on At By DATE CITY AND STATE SIGNATURE Of CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS Of THE POLITICAL REFORM ACT State of California Fair Political Practices Commission Stateatnent Of Organization STATEMENT OF ORGANIZATION Recipient Committee Type or print in ink Page 2 NAME OF COMMITTEE I.D. NUMBER (IF AMENDMENT) Committee To Re —Elect Ron Parks 942505 V Type Of Committee Completing This Statement: COMPLETE THE APPLICABLE SECTION(S). MORE THAN ONE CATEGORY MAY BE APPLICABLE TO YOUR COMMITTEE. SEE REVERSE FOR IMPORTANT INFORMATION AND DEFINITIONS OF THE COMMITTEES LISTED BELOW. Controlled Committee If this committee is controlled by one or more of ficeholder(s) or candidate(s), list the name of each controlling officeholder or candidate. Also list the elective office sought or Field, and district number, if any, for each individual. a If this committee is controlled by one or more officeholder( s) or candidate(s) for partisan office,list the political party with which each officeholder or candidate is affiliated. An officeholderor candidate not holding or seeking a partisan office must indicate "non- partisan.' • If this committee is controlled by a state measure proponent, list the name of the state measure proponent. If thiscommittee is controlled by more than one state measure proponent, list the name of each state measure proponent. If this committee actsjointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE /OFFICEHOLDER/STATE MEASURE PROPONENTICOMMITTEE PARTY ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) Primarily Formed Committee j If primarily formed to support or oppose specific candidates or measures, list the candidates or measures below: CANDIDATE'S NAME OR MEASURE'S FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CAN (INCLUDES DISTRICTT NO. CITY OR COUNTY, AS APPLICAB DICTION CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE I General Purpose Committee If not formed to support or oppose specific candidates or measures, check ONE box to indicate if this is a: ❑ CITY Committee or ❑ COUNTY Committee or ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY S Onsored Committee Provide the nalne and address of the sponsor. If the committee has more than one sponsor, provide names and addresses on appropriately labeled attachment. NAME OF SPONSOR: INDUSTRY GROUP ORAFFILIATION OF - SPONSOR: ADDRESS OF SPONSOR: NO. AND STREET CITY STATE ZIPCODE Broad Based Committee If this is abroad based committee and wishes to make contributions to candidates in excess of the $2,500 contribution limit in connection with a special election, check the box below and enter the date on or before which the committee qualified as abroad based committee. (If the committee is not abroad based committee, or does not wish to make contributions in excess of the $2,500 limit, - do not complete this section.) _ ❑ Check box if this is a broad based committee. Enter the date on or before which the committee qualified as a broad based committee: (Month, Day, Year) ❑ Check box if this committee no longer qualifies as a broad based committee. Statement of Organization WHERE TO FILE: STATEMENT OF ORGANIZATION Recipient Committee 6 \� �,� File original and one copy of this form with: Date Stamp (Government Code Sections 84101-84303) Po "( cretaf State Political l Reform Division or ca Use Onl Sacramento, F Official 3 Y Amendment Sacramento, CA 95852 -1467 vI_l MD FI D FILED El Checkboxif anAmendment And. if Inca t Type Or print in ink and enter LD. number: The city orc ov county one copy o cer, if any, who r eormw h: receives the df A 1019 f�ydf filca tr iiii $18tB or crEy offi re t ffv$It�dCefbRdB committee's original campaign disclosure SEP 011994 SEE INSTRUCTIONS ON REVERSE #— statements. '! I Committee Information If Treasurer and Other Principal Officers Date Qualified as NAME OF TREASURER E Commsttee SMOnth, Day. Ylrr) I Check box if not yet qualified Joseph J. Kuebler I .NAM E CE COMMITT EE MAILING AODRE5S Coomittee To Re -Elect Ran Parks 155 E. 4th St., Ste. 230 CITY STATE 21P CODE . AREA CODEIDAYTIME PHONE ADDRESS OF COMMITTEE (NOT Po BOX) NO. AND STREET Perris, CA 92570 (909)657 -2141 30514 Colina Verde _ NAME AND POSITION OF OTHER PRINCIPAL OFFICERS) CITY 5TATE ZIPCODE AREA CODEI P H ONE NUM BER Te1TEecula CA 92592 (909)676 -4574 MAILING ADDRESS COU N TY OF DO M ICI L E COUNTY WH E RE COMM ITTEE is ACTIVE IF DIFFER ENT THAN COUNTY Or DOMICILE Riverside Riverside CITY STATE ZIP CODE AREA CODEIDAYTIME PHONE I E. hIAIUNG ADDRESS (IF Uri FFRENT) NO. AND S7RE ET OR PO. BOX I) i -' CITY STATE ZIP CODE AREA COD£i PHONE NUMBER Attach additional information on appropriately labeled Continua tion thee U. C i �DispositionofSurplusFundsYoumustSpecifywhatdispositionwillbemadeofleftovercampaignfunds ,ifany,attermination. Donated to Local C11arity IV Verification I have used all reasonable diligence in preparing this Statement and to the best of my knowledge the information Fqntained herein is true and complete. I !t certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 9 -1 _94 At Perris, CA By ,/ Joseph J. Kuebler UAIE city AND STATF 51GIIAiVR[ OI iREAS UTTER T ERT:cuted on 9 -1 -94 At Ferris, CA By A 14, Ron Par _ DATE CITY AND STATE $IWIATLIWEN COM ROL•UNGOf HCEHOLDEA.CANDIDATE, W STATE MEASURE PAORONEhE Executed on At By — pAIE CITY AND STATE SIGIIAIUAE Of CONTACKLAK OTTICf HOE DA. CANDIDALL, ORAAIE NEASUAF PROPONUII 7 Executed on At By DATE CIT'r AIID STATE SIG IIA TUBE OF CONTROS LING OF OCE HOLD E R. CA NDIOA If. CAE S FATE MEASURE IROPONE NE fOR IN F OR1AATW N It EOmRED TO at FROM DE D IO YOU eURSUA III TO 111E INFORMATION FMCTICIS ACT Or 1911, NE INI ORMATI MANUAL ON CAMPAIGN DISCLUSU PPOVI SIONS OF THE PCHUTFCAL REFOIIM ACT. State of California Fair Political Practices Commission F Statement of Organization STATEMENT OFORGANIZAT[ON Recipient Committee Type or print in ink Page t NANIE OF COMMITTEE I.D. NUMBER (IF AMENDMENT) Committee To Re -Elect Ron Parks V Type Of Committee Completing This Statement: COMPLETE THE APPLICABLE SECTION(S). MORE THAN ONE CATEGORY MAY BE APPLICABLE TO YOUR COMMITTEE. SEE REVERSE FOR IMPORTANT IN AND DE O TH C OMMITTEES LISTED BELOW. I Controlled Committee I • If thls:ommittee is controlled by one or more officeholder(sl or candidate(s). fist the nameof each controlling officeholderor candidate.A)solist the elective officesoughtor field, and district number, it any, for each individual. •• If this committee is controlled by one or more officeholder(s)or candidate(s) for partisan office, listthe political party with which each officeholder or candidate is affiliated. An officeholder or candidate not holding or seeking a partisan office must indicate 'non-partisan. • If this committee is controlled by a state measure proponent, list the name of the state measure proponent- Ifthis committee is controlled by more than one state measure proponent ,listthe name of each state measure proponent. I. • If thiscommittee acts jointly with another controlled committee, listthe name and identification numberof theothet controlled committee. NAME OF CANDIDATE!OFFICEHOLDEFL'STATE MEASURE PROPONENT/COMMETTEE PARTY ELECTIVE OFFICE SOUGHTOR HELD(INCLVOE DISTRICT NUMBER IF APPLICABLE) Ron Parks Rep. City Couneil - Temedula Pr,marilyFormeo'Committee If primarily formed to support or oppose specific candidates or measures. listthe candidatesor measures below: CANDIDATE'S TUD OFFICE SOUGHT O. CI HELD OR COUN ME URE'SJUURR.ISDiCTION CNECx ONt CAtJ OIDATE'S NA OR MEASURE'S FULL TITLE (INCLUDE BALLOT N O.OR LETTER) r. wrrom OPI'OSL _ I weroat oerost AIL General P urpose Comm ittee , not formed to support or oppose specific candidates or measures, check ONE box to indicate if this is a: ❑ CTTY Committee or ❑ COUNTY Committee or ❑ STATECommittee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Sponsored Committee Provide thenar leandaddr essof thesponsor. ifthecommitteehasmorethanonesponsor, providenamesandaddressesonappropriately labefedattachmem. t NAMEOF SPONSOR: INDUSTRY GROUP ORAFFILIATION OF t SPONSOR: ADDRESS OF SPOP)SOR: NO,ANDSTREET CITY STATE ZiPCOUE Broad Based Committee t If thisisa broad based committee and wishes to make contributions to candidates in excess of the S2, SODcontribution limit inconnectionwitha special efechon,check the box belowand enter the dale on of be fore which the committee qualified as abroad based committee_ (tithe committee is not abroad based committee, or does not wish to make contributions in excess of the $2,500 limit, donotcomplete tlhiss ction.) ❑ Check box if thisisa broad based committee. Enter the date on or before which the committee qual'Aie: as a broad based committee: (Month; Day. Year) ❑ Check box if this committee no longer qualifies as abroad based committee. Statement of Or WHERE TO FILE: STATEMENT OF ORGANIZATION Recipient Committee File original and one copy of this form with: (Government Code Sections 84101 - 84103) Political State I { R i t• ti r 1 1 j Political l Reform Division v U P.O. Box 1467 For Official Use Only Amendment Sacramento. CA 95812 -1467 SEP 14 1994 0 Check box if an Amendment And, If applicable, file one copy of this form with: Type or print in ink and enter I.D. number: y The city or county officer, if any, who receives the 8 942505 committee's original campaign disclosure SEE INSTRUCTIONS ON REVERSE N statements. Committee Information II Treasurer and Other Principal Officers Date Qualified as NAME OF TREASURER Committee (MOn1h. DAY. YnD 9 -9 -94 ❑ Check box if not yet qualified NAME OF COMMITTEE MAILING ADDRESS Committee To Re —Elect Ron Parks I CITY STATE ZIP CODE AREA CODE /DAYTIME PHONE ADDRESS OF COMMITTEE (NOT P.O. BOX) NO. AND STREET NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S) CITY STATE ZIP CODE AREACODE /PHONE NUMBER MAILING ADDRESS COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE CITY STATE ZIP CODE AREA CODE /DAYTIME PHONE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE I AREA CODE/ PHONE NUMBER Attach additional information on appropriately labeled continuation sheets. III Disposition of Surplus Funds You must specify what disposition will be made of leftover campaign funds, if any, at termination. Adilk IV Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information Pcnt in ed herein is ue and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 9 -12 -94 At Perris, CA B I,/ 9-12-94 J. Ruebler DATE CITY AND STATE IGNATURE OF TREASURER Executed on 9 -12 -94 At Perris, CA By V hf 1p, /��'`��" Ron Parks DATE CITY AND STATE SIG IUREOf NI ROLLING OFFICEHOLDER, CANDIDATE, OR STATE M EASURE PROPONENT Executed on At By DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT Executed on At By DATE CITY AND STATE SIGNATURE 01 CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT FOR INFORMATION REOUME D TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977. SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS Of THE POLITICAL REFORM ACT. State of California Fair Political Practices Commission Sfatement of Organization STATEMENT OF ORGANIZATION Recipient Committee Type or print in ink Pape 2 NAME OF COMMITTEE I.D. NUMBER (IF AMENDMENT) Committee To Re —Elect Ron Parks 942505 V Type of Committee Completing This Statement: COMPLETE THE APPLICABLE SECTION(S). MORE THAN ONE CATEGORY MAY BE APPLICABLE TO YOUR COMMITTEE. SEE REVER F IMPORTANT INF AN DEFINITI O F THE COMM L I S T E D BEL Controlled Committee • If this committee is controlled by one or more officeholder( s) or candidate(s), list the name of each controlling officeholder or candidate. Also list the elective office soughtor held, and district number, if any, for each individual. • If this committee is controlled by one or more off iceholder( s) or candidate(s) for partisan office,list the political partywith which each officeholder or candidate is affiliated. An officeholder or candidate not holding or seeking a partisan office must indicate "non- partisan.' • If this committee is controlled by a state measure proponent, list the name of the state measure proponent. if this committee is controlled by more than one state measure proponent, list the name of each state measure proponent. • If this committee actsjointlywith another controlled committee, listthe name and identification number of the other controlled committee. NAME OF CAN DIDATE/ OFFICEHOLDER /STATE MEASURE PROPONENT /COMMITTEE PARTY ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) Primarily formed Committee I If primarily formedto support or oppose specific candidates or measures, list the candiclatesor measures below: CANDIDATE'S OFFICE CT NO., IT HELD R C OR MEASURE'S JURISDICTION CANDIDATE'S NAME OR MEASURE'S FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT SOU C O COUNTY,AS APPLICABLE) CHECK ONE SUPPORT OPPOSE I SUPPORT OPPOSE I General Purpose Committee If not formed to support or oppose specific candidates or measures, check ONE box to indicate if this is a: ❑ CITY Committee or ❑ COUNTY Committee or ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY - • Sponsored Committee I Provide the name and address of the sponsor. If the committee has more than one sponsor, provide names and addresses on appropriately labeled attachment. NAME OF SPONSOR: INDUSTRY GROUP OR AFFILIATION OF SPONSOR: ADDRESS OF SPONSOR: NO. AND STREET CITY STATE ZIP CODE Broad Based Committee If this is abroad based committee and wishes to make contributions to candidates in excess of the $2,500 contribution limit in connection with a special election, check the box below and enter the date on or before which the committee qualified as a broad based committee. (If the committee is not a broad based committee, or does not wish to make contributions in excess of the $2,500 limit, do not complete this section.) . ❑ Check box if this is a broad based committee. Enter the date on or before which the committee qualified as a broad based committee: (Month, Day, Year) ❑ Check box if this committee no longer qualifies as a broad based committee. - s L. o FILE AN ORIGINAL AND ONE AND, IF APPLICABLE. FILE ONE COPY OF THIS FORM WITH: COPY OF THIS FORM WITH: Se�r�tary o SMte The cot or county Won g th ocer, H any, the 5f.!. o'. - Caliiernio Pditlul Re�orm Division hom the tommlhee must file Its JUL 311989 . P.O. Box 1467 +,k (AL o al campaign diuiosure Sacrm a ento, CA P7. 31 W nor emenU J A 4 1 N 7gNT 9 F form 410 ` � OR�i Q me Art 2� NS(RECIPIENT COMMITTEEW.?CH FONC EJ, Sary o r St" N fN mom Ba IOI Ba 1031 1989 EM ER I.D. NUMBfA (Type or Print In Ink) _ FULL NAME OF COMMITTEE: Committee To Elect Ron Parks City Councilman STREET ADDRESS OF COMMITTFF- w.A urn all SIAII rvcooE COUNTY: y1O1O 28441 Rancho California Road, Suite R, Temecula, CA 9239 Riv erside MAILING ADDRESS (IF DIFFERENT): No Arlo uru too r o aoAi Coll VAR is C001 Same DATE QUALIFIED AS COMMITTEE Wo.",CoI. AASA Coot n,oiit M UUMA IA FOROWCUIUSEONLY 8 FOROFFICMLUSEON 7 -20 -89 (714) 676 -6726 1 TREASURER AND OTHER PRINCIPAL OFFICERS POSITION NAME AND ADDRESS AND MAILING ADDRESS, IF DIFFERENT AREA BUSINESS ODE) PHONE NO TREASURER Joseph J. Kuebler 146 E. Fourth St., Perris, CA 92390 714 657 -2141 Attach additional lnforrrnation on Approprkare l abeled conri sheen II IS THIS ABROAD BASED POLITICAL COMMITTEE] (See definition and important information on reverse.) ❑ YES Enter the date on or before which the committee qualified as a broad ® NO based committee: III IS THIS COMMITTEE CONTROLLED BY A CANDIDATE, OFFICEHOLDER OR STATE MEASURE PROPONENT] (See definition and important information on reverse.) © YES (Complete the following) [, NO IF THIS COMMITTEE IS CONTROLLED BY AN OFFICEHOLDER OR A CANDIDATE. THE NAME OF THE CONTROLLING CANDIDATE OR OFFICEHOLDER. THE ELECTIVE OFFICE SOUGHT OR HELD AND DISTRICT NUMBER, if ANY, MUST BE LISTED. IF THIS 15 A BALLOT MEASURE COMMITTEE CONTROLLED By MORE THAN ONE CANDIDATE, THE NAME OF EACH CONTROLLING CANDIDATE MUST BE LISTED, IF THIS COMMITTEE IS CONTROLLED BY A STATE MEASURE PROPONENT, THE NAME OF THE STATE MEASURE PROPONENTMUST BE LISTED. Ron Parks, City Council, Temecula, CA Attach aol�tiasM EnfomMtlon on atawBwfabh IaaeFrd conUrRMwn them IV IS THIS COMMITTEE ACTING JOINTLY WITH OTHER COMMITTEES7 ❑ YES (Complete the following) ® NO NAMES OF COMMITTEES WITH WHICH THIS COMMITTEE ACTS IOINTLY. ALSO PROVIDE THE COMMITTEES' IDENTIFICATION NUMBERS OR THE TREASURERS' NAMES AND PERMANENT STREET ADDRESSES. Attadn additlorkd in/armatian on appopriatdy4WNdcon (rwwrion aheotA YOU MUST COMPLETE THE VERIFICATION ON PAGE 2 Fa information required to be provAlW to you pwsiA nt to the Information )Y CTIrn AR of 1977. Me 4 01 winit,tw Manual on C.n,p.,gn D�scmm.e Provisortt of the Pol ROW171 An. • - 103 - - — NAME OF -' COMMITTEE V IS THIS A SPONSORED COMMITTEE7 (Refer to the instructions on the reverse side for definitions and rules regarding the name of a sponsored committee.) AaC A, 4 85 ® No 11119016TRO uF v4TUR U YES (Provide name and address of sponsor. If the committee has more th "l01!AW0R&4Ye the name and address of each sponsor on an attachment.) Name of Sponsor: - Address of Sponsor: VI IF PRIMARILY FORMED TO SUPPORT OR OPPOSE SPECIFIC CANDIDATES OR MEASURES, LIST SPECIFIC CANDIDATES OR MEASURES SUPPORTED OR OPPOSED. CANDIDATE'S NAME/MEASURE'S FULL TITLE SUPPORT OPPOSE OFFICE SOUGHT OR HELD BY CANDIDATE OR MEASURE'S INCLUDING BALLOT NUMBEROR LETTER )URISDICTION (Include dTstnR number, city or county, as appbcab)e ) Ron Parks x City Council, Temecula, Riverside County,C. Attach additio inf o n appropriat labeled continuation sheets. VII COMMITTEE'S PRINCIPAL ACTIVITY IF NOT SUPPORTING OR OPPOSING SPECIFIC CAND IDATES OR MEASURES - PLEASE CHECK BOX TO INDICATE THE COMMITTEE'S LEVEL OF ACTIVITY: E]CI7Y ❑ U rn [] CO LINTY L: STATE Attach additional information on appropriately labeled continuation sheets. VIII YOU MUST SPECI WHA DI WILL BE MADE OF SURPLUS FUNDS IN THE EVENT OF TERMINATION. Loan Repayment VERIFICATION I HAVE USED ALL REASONABLE D"ENCE IN PREPARING THIS STATEMENT. I HAVE RENEWED THE STATEMENT ND T HE BEST OF MY KNOWLEDGE THE INFORMATION CONTAINED HEREIN IS TRUE AND COMPLETE. 1 CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THI STATE OF CAUFQFAtA WW TH[ FOOEGOIN IS COMER. EXECUTEDO 7 -25 -$9 AT Perris , CA BY (DATER (OTT AND LIATI) - - tl goXPAASuXt o e J KyAeb er EXECUTED ON -25 -89 AT Perris, CA- By ���- -mot /> jIE� � yY " Y =- (GATE) (OTT AND STATIC (LGWIANOP ONTROLLU10 11. F � HMC ORF A r a rl�s HFn EXECUTED ON AT By E� [DATE) (OTY A111) STATII BW(MT Dr co"T OLNOOATI. OrFTLINDLDIA W STATE WAsum PropomiNn EXECUTED ON AT BY (DATE) (OTT AND STATE) (N4IYTURF CD FT LU(6(A ATI.WFMN MRDA STATIMIASURAOMPOMNn -104-