Form F-1 - Application For Filing Of Franchise Offering Circular - Department Of Commerce And Consumer Affairs Page 2


) ss.
being first duly sworn on oath deposes and says that he/she
is the
the applicant named in the foregoing application, that he/she
is authorized to make this verification for and on behalf of said
; that he/she has read the application and all the exhibits,
statements and documents attached thereto; that the information contained in the application, exhibits, statements and documents is
true to the best of his/her information, knowledge and belief.
Signature of Applicant)
Subscribed and sworn to before me this
day of
, 20
Notary Public, State of
My commission expires:


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