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OCR Page 1 of 3STATE OF
SS.
COUNTY OF
I,
, of
(President, Treasurer or Cashier)
(Name of Corporation)
do solemnly swear that the above statement is true and correct.
Given under my hand and seal of the corporation on the
day of
, 191
Attest:
For
Secretary.
(Name of Corporation)
Subscribed and sworn to before me this
day of
, 191
Notary Public.
My commission expires
day of
191
9
Correspondence concerning the above corporation should be addressed to :
(Name)
(Street Address)
(City and State)
TRUMAN
3
ARE
"NATIONAL
ARCHIVES AND
RECORDS
SERVICE"
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