Choice, Willie Edward

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STATE 'nF TE)(> 'H'€J' l€KO\S 397 0 4 . 1 decl nder penalty of
(County) (State) (Zip Code)

perjury that the foregoing is true and correct
Executed on the_¥,) day of f:éér . 20 /S. ` G`_"* "

/ /Q@ffender Signature)