div class=ts-pagebuttonPage 1button div class=ts-image amp-img class=ts-thumb alt=Page 1: EPACOLE-001005-20171102135201epaohiogovPortals42documentsVWOhio signed Beneficiary CertificationpdfCase 3:16-cv-00295-CRB Document 51-1 Filed 100217 Page 67 of 80 the Beneficiarys src=https:reader033vdocumentsusreader033viewer20220503125f7477f536ddc30c020cf454html5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 2button div class=ts-image amp-img class=ts-thumb alt=Page 2: EPACOLE-001005-20171102135201epaohiogovPortals42documentsVWOhio signed Beneficiary CertificationpdfCase 3:16-cv-00295-CRB Document 51-1 Filed 100217 Page 67 of 80 the Beneficiarys src=https:reader033vdocumentsusreader033viewer20220503125f7477f536ddc30c020cf454html5thumbnails2jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 3button div class=ts-image amp-img class=ts-thumb alt=Page 3: EPACOLE-001005-20171102135201epaohiogovPortals42documentsVWOhio signed Beneficiary CertificationpdfCase 3:16-cv-00295-CRB Document 51-1 Filed 100217 Page 67 of 80 the Beneficiarys src=https:reader033vdocumentsusreader033viewer20220503125f7477f536ddc30c020cf454html5thumbnails3jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 4button div class=ts-image amp-img class=ts-thumb alt=Page 4: EPACOLE-001005-20171102135201epaohiogovPortals42documentsVWOhio signed Beneficiary CertificationpdfCase 3:16-cv-00295-CRB Document 51-1 Filed 100217 Page 67 of 80 the Beneficiarys src=https:reader033vdocumentsusreader033viewer20220503125f7477f536ddc30c020cf454html5thumbnails4jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 5button div class=ts-image amp-img class=ts-thumb alt=Page 5: EPACOLE-001005-20171102135201epaohiogovPortals42documentsVWOhio signed Beneficiary CertificationpdfCase 3:16-cv-00295-CRB Document 51-1 Filed 100217 Page 67 of 80 the Beneficiarys src=https:reader033vdocumentsusreader033viewer20220503125f7477f536ddc30c020cf454html5thumbnails5jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 6button div class=ts-image amp-img class=ts-thumb alt=Page 6: EPACOLE-001005-20171102135201epaohiogovPortals42documentsVWOhio signed Beneficiary CertificationpdfCase 3:16-cv-00295-CRB Document 51-1 Filed 100217 Page 67 of 80 the Beneficiarys src=https:reader033vdocumentsusreader033viewer20220503125f7477f536ddc30c020cf454html5thumbnails6jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 7button div class=ts-image amp-img class=ts-thumb alt=Page 7: EPACOLE-001005-20171102135201epaohiogovPortals42documentsVWOhio signed Beneficiary CertificationpdfCase 3:16-cv-00295-CRB Document 51-1 Filed 100217 Page 67 of 80 the Beneficiarys src=https:reader033vdocumentsusreader033viewer20220503125f7477f536ddc30c020cf454html5thumbnails7jpg width=142 height=106 layout=responsive amp-img divdiv