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<br />. <br /> <br />e <br /> <br />If any contingency clause or contract tenns involve additional panies, list all individuals or officers, if a <br />corporation, pannership or trust. <br /> <br />For any changes of ownership or changes in contracts for purchase subsequent to the date of the <br />application, but prior to the date of final public hearing, a supplemental disclosure of interest shall be <br />filed. <br /> <br />The above is a fuU disclosure of aU panies of interest in the application to the best of my knowledge <br />and belief. <br /> <br />Signature: <br /> <br />(Applicant) <br /> <br />Sworn to and subscribed before me, <br /> <br />This ~ day of I#k~ <br />. <br /> <br />, 200 'i <br /> <br /> <br /> <br />(Seal) <br /> <br />':- Disclosure shall not be required of any entity; the equiry interest is which are regularly traded on an <br />established securities market in the United States or other country; or any entiry, the ownership <br />interest of which are held in a limited pannership consisting of more than 5,000 separate interest and <br />where no one person or entiry holds more than a total of 5% of the ownership interest in the limited <br />pannership. <br /> <br />PH2005 ed <br /> <br />15 <br />