਀  㰀琀愀戀氀攀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀吀愀戀氀攀 戀漀爀搀攀爀㴀　 挀攀氀氀瀀愀搀搀椀渀最㴀　 眀椀搀琀栀㴀　 猀琀礀氀攀㴀✀眀椀搀琀栀㨀㘀　　⸀　瀀琀㬀 mso-cellspacing:1.5pt;mso-yfti-tbllook:1184'>਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀　㬀洀猀漀ⴀ礀昀琀椀ⴀ昀椀爀猀琀爀漀眀㨀礀攀猀㬀洀猀漀ⴀ礀昀琀椀ⴀ氀愀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀栀㈀ 愀氀椀最渀㴀挀攀渀琀攀爀 猀琀礀氀攀㴀✀琀攀砀琀ⴀ愀氀椀最渀㨀挀攀渀琀攀爀✀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀 "Times New Roman"'>Lone Star Model A Ford Club
਀    刀攀焀甀攀猀琀 䘀漀爀 倀愀礀洀攀渀琀⼀刀攀椀洀戀甀爀猀攀洀攀渀琀 䘀漀爀洀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀   㰀⼀琀爀㸀 ਀  㰀⼀搀椀瘀㸀

਀  㰀琀愀戀氀攀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀吀愀戀氀攀 戀漀爀搀攀爀㴀　 挀攀氀氀瀀愀搀搀椀渀最㴀　 猀琀礀氀攀㴀✀洀猀漀ⴀ挀攀氀氀猀瀀愀挀椀渀最㨀 1.5pt;mso-yfti-tbllook:1184'>਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀　㬀洀猀漀ⴀ礀昀琀椀ⴀ昀椀爀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀䐀愀琀攀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

Vendor

਀    㰀⼀琀搀㸀 ਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀䐀攀猀挀爀椀瀀琀椀漀渀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

Amount

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㄀✀㸀 ਀    㰀椀渀瀀甀琀 琀礀瀀攀㴀搀愀琀攀 渀愀洀攀㴀䐀愀琀攀㄀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀⼀琀搀㸀 ਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀䤀一倀唀吀 吀夀倀䔀㴀∀琀攀砀琀∀ 匀䤀娀䔀㴀∀㔀　∀ 一䄀䴀䔀㴀∀䐀攀猀挀爀椀瀀琀㄀∀㸀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀 ਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㈀✀㸀 ਀    㰀椀渀瀀甀琀 琀礀瀀攀㴀搀愀琀攀 渀愀洀攀㴀䐀愀琀攀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀⼀琀搀㸀 ਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀䤀一倀唀吀 吀夀倀䔀㴀∀琀攀砀琀∀ 匀䤀娀䔀㴀∀㔀　∀ 一䄀䴀䔀㴀∀䐀攀猀挀爀椀瀀琀㈀∀㸀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀 ਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㌀✀㸀 ਀    㰀椀渀瀀甀琀 琀礀瀀攀㴀搀愀琀攀 渀愀洀攀㴀䐀愀琀攀㌀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀⼀琀搀㸀 ਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀䤀一倀唀吀 吀夀倀䔀㴀∀琀攀砀琀∀ 匀䤀娀䔀㴀∀㔀　∀ 一䄀䴀䔀㴀∀䐀攀猀挀爀椀瀀琀㌀∀㸀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㐀✀㸀 ਀    㰀椀渀瀀甀琀 琀礀瀀攀㴀搀愀琀攀 渀愀洀攀㴀䐀愀琀攀㐀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀⼀琀搀㸀 ਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀䤀一倀唀吀 吀夀倀䔀㴀∀琀攀砀琀∀ 匀䤀娀䔀㴀∀㔀　∀ 一䄀䴀䔀㴀∀䐀攀猀挀爀椀瀀琀㐀∀㸀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㔀㬀洀猀漀ⴀ礀昀琀椀ⴀ氀愀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀吀漀琀愀氀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀㰀⼀琀搀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀栀㈀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀 ਀    ⬀  ਀    㴀 㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀栀㈀㸀

਀    㰀⼀昀漀爀洀㸀 ਀   㰀⼀琀爀㸀 ਀  㰀⼀琀搀㸀 ਀ 㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㄀✀㸀 ਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀刀攀洀椀琀 to Payee: (ONE PAYEE PER FORM)

਀  㰀琀愀戀氀攀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀吀愀戀氀攀 戀漀爀搀攀爀㴀　 挀攀氀氀瀀愀搀搀椀渀最㴀　 猀琀礀氀攀㴀✀洀猀漀ⴀ挀攀氀氀猀瀀愀挀椀渀最㨀 1.5pt;mso-yfti-tbllook:1184'>਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀　㬀洀猀漀ⴀ礀昀琀椀ⴀ昀椀爀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀一愀洀攀㨀

਀    㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀䤀一倀唀吀 吀夀倀䔀㴀∀琀攀砀琀∀ 匀䤀娀䔀㴀∀㌀　∀ 一䄀䴀䔀㴀∀一愀洀攀∀ required>

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㄀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀䄀搀搀爀攀猀猀㨀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀   㰀⼀琀爀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀䤀一倀唀吀 吀夀倀䔀㴀∀琀攀砀琀∀ 匀䤀娀䔀㴀∀㌀　∀ 一䄀䴀䔀㴀∀䄀搀搀爀攀猀猀㈀∀ required>

਀    㰀⼀琀搀㸀 ਀  㰀⼀琀愀戀氀攀㸀 ਀ 㰀⼀琀爀㸀 ਀  㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀✀㸀

 ਀  㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀ 㰀⼀琀爀㸀 ਀  㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀✀㸀

Requestor's

਀  㰀琀愀戀氀攀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀吀愀戀氀攀 戀漀爀搀攀爀㴀　 挀攀氀氀瀀愀搀搀椀渀最㴀　 猀琀礀氀攀㴀✀洀猀漀ⴀ挀攀氀氀猀瀀愀挀椀渀最㨀 1.5pt;mso-yfti-tbllook:1184'>਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀　㬀洀猀漀ⴀ礀昀琀椀ⴀ昀椀爀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀一愀洀攀㨀

਀    㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀䤀一倀唀吀 吀夀倀䔀㴀∀琀攀砀琀∀ 匀䤀娀䔀㴀∀㌀　∀ 一䄀䴀䔀㴀∀刀一愀洀攀∀ required>

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㄀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀匀椀最渀愀琀甀爀攀㨀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㈀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀倀栀漀渀攀㨀

਀    㰀⼀琀搀㸀 ਀    㰀椀渀瀀甀琀 琀礀瀀攀㴀琀攀氀 猀椀稀攀㴀㄀㐀 渀愀洀攀㴀倀栀漀渀攀 瘀愀氀甀攀㴀∀∀ 爀攀焀甀椀爀攀搀㸀 ਀   㰀⼀琀爀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

Date:਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀 ਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㐀㬀洀猀漀ⴀ礀昀琀椀ⴀ氀愀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀䔀洀愀椀氀㨀

਀    㰀⼀琀搀㸀 ਀    㰀椀渀瀀甀琀 琀礀瀀攀㴀攀洀愀椀氀 猀椀稀攀㴀㌀㔀 渀愀洀攀㴀攀洀愀椀氀 瘀愀氀甀攀㴀∀∀ 爀攀焀甀椀爀攀搀㸀 ਀   㰀⼀琀爀㸀 ਀  㰀⼀琀搀㸀 ਀ 㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㐀✀㸀 ਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀☀渀戀猀瀀㬀

਀  㰀⼀琀搀㸀 ਀ 㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㔀✀㸀 ਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀刀攀挀攀椀瀀琀猀 / Invoices Enclosed:Yes No਀  㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀ 㰀⼀琀爀㸀 ਀  㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀✀㸀

Comments:਀ 㰀⼀琀爀㸀 ਀  㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀✀㸀

਀  㰀⼀琀搀㸀 ਀ 㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㠀✀㸀 ਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀☀渀戀猀瀀㬀

਀  㰀⼀琀搀㸀 ਀ 㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㤀✀㸀 ਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀刀攀瘀椀攀眀攀搀 and Approved by a Board Member

਀  㰀琀愀戀氀攀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀吀愀戀氀攀 戀漀爀搀攀爀㴀　 挀攀氀氀瀀愀搀搀椀渀最㴀　 猀琀礀氀攀㴀✀洀猀漀ⴀ挀攀氀氀猀瀀愀挀椀渀最㨀 1.5pt;mso-yfti-tbllook:1184'>਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀　㬀洀猀漀ⴀ礀昀琀椀ⴀ昀椀爀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

President਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

For਀    琀栀攀 倀爀攀猀椀搀攀渀琀✀猀 瀀甀爀挀栀愀猀攀猀 㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀   㰀⼀琀爀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

Name:਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

Felix਀    䈀漀猀琀漀渀 㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

___________________________________਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀   㰀⼀琀爀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

Signature:

਀    㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开☀渀戀猀瀀㬀☀渀戀猀瀀㬀☀渀戀猀瀀㬀㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

___________________________________਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀   㰀⼀琀爀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

Date:਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

___________਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

___________਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀   㰀⼀琀爀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

 ਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀㰀⼀琀搀㸀 ਀   㰀⼀琀爀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀

 ਀    㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀    㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀 ⸀㜀㔀瀀琀✀㸀㰀⼀琀搀㸀 ਀   㰀⼀琀爀㸀 ਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀㬀 display:none;mso-hide:all'> 

਀  㰀琀愀戀氀攀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀吀愀戀氀攀 戀漀爀搀攀爀㴀　 挀攀氀氀瀀愀搀搀椀渀最㴀　 猀琀礀氀攀㴀✀洀猀漀ⴀ挀攀氀氀猀瀀愀挀椀渀最㨀 1.5pt;mso-yfti-tbllook:1184'>਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀　㬀洀猀漀ⴀ礀昀琀椀ⴀ昀椀爀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀䌀栀攀挀欀 Number

਀    㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀开开开开开开开开开开开

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㄀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀吀爀攀愀猀甀爀攀爀㨀

਀    㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀䨀漀攀 Hocker

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㈀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀匀椀最渀愀琀甀爀攀㨀

਀    㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开开

਀    㰀⼀琀搀㸀 ਀   㰀琀爀 猀琀礀氀攀㴀✀洀猀漀ⴀ礀昀琀椀ⴀ椀爀漀眀㨀㌀㬀洀猀漀ⴀ礀昀琀椀ⴀ氀愀猀琀爀漀眀㨀礀攀猀✀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀䐀愀琀攀㨀

਀    㰀⼀琀搀㸀 ਀    㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀开开开开开开开开开开开

਀    㰀⼀琀搀㸀 ਀  㰀⼀琀愀戀氀攀㸀 ਀ 㰀⼀琀爀㸀 ਀  㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀✀㸀

 ਀  㰀漀㨀瀀㸀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀ 㰀⼀琀爀㸀 ਀  㰀琀搀 猀琀礀氀攀㴀✀瀀愀搀搀椀渀最㨀㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀 ㈀⸀㈀㔀瀀琀✀㸀 ਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀☀渀戀猀瀀㬀☀渀戀猀瀀㬀☀渀戀猀瀀㬀☀渀戀猀瀀㬀☀渀戀猀瀀㬀☀渀戀猀瀀㬀☀渀戀猀瀀㬀☀渀戀猀瀀㬀          ਀  㰀椀渀瀀甀琀 琀礀瀀攀㴀戀甀琀琀漀渀 瘀愀氀甀攀㴀瀀爀椀渀琀 漀渀挀氀椀挀欀㴀∀眀椀渀搀漀眀⸀瀀爀椀渀琀⠀⤀㬀∀㸀         Version 1b

਀  㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀㬀 display:none;mso-hide:all'> 

਀  㰀⼀琀搀㸀 ਀㰀⼀琀愀戀氀攀㸀 ਀㰀⼀搀椀瘀㸀 ਀㰀瀀 挀氀愀猀猀㴀䴀猀漀一漀爀洀愀氀㸀㰀猀瀀愀渀 猀琀礀氀攀㴀✀洀猀漀ⴀ昀愀爀攀愀猀琀ⴀ昀漀渀琀ⴀ昀愀洀椀氀礀㨀∀吀椀洀攀猀 一攀眀 刀漀洀愀渀∀✀㸀㰀漀㨀瀀㸀☀渀戀猀瀀㬀㰀⼀漀㨀瀀㸀㰀⼀猀瀀愀渀㸀㰀⼀瀀㸀 ਀㰀⼀搀椀瘀㸀 ਀㰀⼀戀漀搀礀㸀 ਀㰀⼀栀琀洀氀㸀