Form D-1 - Notice Of Sale Of Securities Pursuant To The Delaware Limited Offering Exemption Form - State Of Delaware Page 4

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By signing this Form D-1, the issuer represents and affirms that it has compiled
with all of the conditions of the exemption which is being claimed and that the
information provided herein is true and correct.
Signed: ____________________________________ Date: _____________
Name and Title (Please print or type)
State of Delaware
Revised: January 5, 2000
Department of Justice
Division of Securities
820 N. French Street
Wilmington, DE 19801
4

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