Form Dscb:15-138-2 - Statement Of Correction Page 2
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2DSCB:15-138–2
Check one of the following:
5.
The portion of the document requiring correction in corrected form is set forth in Exhibit A attached hereto
and made a part hereof.
The original document to which this statement relates shall be deemed re-executed.
The original document to which this statement relates shall be deemed stricken from the records of the
Department.
IN TESTIMONY WHEREOF, the undersigned
association or other person has caused this statement to be
signed by a duly authorized officer thereof or otherwise in
its name this
day of
,
.
Name
Signature
Title
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