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STATE OF NORTH DAKOTA <br />County of.....~.~(ffe'.~ <br />............. (~('~.~X...~/.~]~.~g1 .......................... being first duly sworn, deposes and says <br />that he is the ..................................................... applicant who is described hi and wbo cxecutcd the foregoing <br /> <br />and above application, that he bas read each question and statement tberein contained and knows the contents tbereof, <br />and that he has made the answers set forth in said application, and tbat each one of said answcrs is truc of ]lis own <br />knowledge. <br /> <br /> Subscribed and sworn to before me on this .......... C~g~'- ........ '-'---'-'"'dav'°f'""~.L~2~'~'"!"'~'~'"~' <br /> <br /> Notary Public for ........ I..21~.3~M~ ............................ <br /> (SEAL) Count>', North Dakota. <br /> My commission expirea ..................... <br /> <br /> NotaW public <br /> Slate of No~th Dakota · ,, <br /> <br /> <br />