Form 251 - Application For Amended Certificate Of Authority - 2005 Page 2
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1
2Under penalty of perjury, we declare and affirm that we have
examined this Application for Amended Certificate of Authority,
including
any
accompanying
attachments,
and
that
all
statements contained herein are true and correct.
Date:
Print Exact Name of Corporation Making Application
By _________________________________________________
President or
Vice President
(check one)
AND
By _________________________________________________
Secretary or
Assistant Secretary (check one)
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