part - i -' name ar-vif·rlji?~ o-~,;l g7hra~liu d · -1to 9: details of ejections funds and...

10
ABSTRACT STATEMENT OF ELECTION EXPENSES --- 1 PART - I -' - - - ---------_._------ -------- HAR-Vif rlJi?~ Name ul t.lu: C;illdir!;Jtp Sh.jSmt.j Km. .---_. __ ._--- 11 Number and name of Constituency o-~,;l G7HrA~lIu N D A -- ___ L-- _____ ...•.. ___ -- ---- .. ' .._- [11 Name of StCltP/llnion Tcr ritory MARVANA - ----- IV Nature of Election (Please mention whether General STATE A8S ~ I Election to State Assembly / Lok I-V- .5abh~BJ:'e_~_lectio~J --- Date of declaration of result 19 - 10 - ::2014 -- --- VI Name and Address of the Election KULDE fP S.IN -- Agent VII If candidate is set up by a political party, Please mention the name of the e. JQ P. political pa~ VIII Whether the party is a recognised Yes/~ politicalQ?rtl ---------------1 IY'JBL'j ...J Date: Signature of the Candidate Place: Name Amt. Amt. Amt. Incurred Incurred/ Incurred / Auth. by authorize / Candidate d by Po!. authorize / Election Party d by agent(in (in Rs.) others Rs.) (in Rs.) 3 4 5 --- ..- - - q4:t7~ - Total Election expenditure PART-I!: ABSTRACT OF STATEMeNT OF ELECTION EXPENDITURE OF CANDIDATE S. No_ Particulars (3)+:4)+(5) ~--~~-------------------_+~~--~----~~~L-_+~---------------~ ~----71~2------~----~--------~----~ ~----+-~6-- ----~ .!' Expenses in public meeting, rally, procession elC:- _;I: Expenses in public meeting, rally, procession etc. (ie: other than the ones with Star Campaigners of the Political party (Enclose as per Schedule-L) 1--__ ~"'--------'-.JL.:...:....::...::.'--'--'-'~c:....::.L-------_+----~+_---_+__----+--- .. -! 1 1. b Expenditure in public meeting rally, + orocession etc. with the Star Campaigner(s) (ie: _ 343 6.~o '4.,--' S"2.P _ l O:-hel than those for general party propaganda) f----- (Enclose as per Schedule~_:_--_:_ __ :__+_----_i 11 Campaign materials other than those used in the 56' 41:2 :19~~73 3T,-~-lj g s- '-- __ -"-:.::.r.au=-:b:.:l:.::ic..::m:.:.:e:..:e:.:;ti:.:.:llco.g"!....:r..:::a.:.:llyL!.,,.l:p:.:..Jr.::..oc:.::e:::s::::.si:::..on::..::.et:::c.:..:. m:.:::::cn:.:.:t:.:..:io:..:.n:::cc=.d_..L .L- .-L. -L _ -I 443

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Page 1: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

ABSTRACT STATEMENT OF ELECTION EXPENSES--- 1

PART - I

-'- - - ---------_._------ -------- HAR-Vif·rlJi?~Name ul t.lu: C;illdir!;Jtp Sh.jSmt.j Km. .---_.__ ._---

11 Number and name of Constituency o-~,;l G7HrA~lIu N D A-- ___ L-- _____ ...•..___ -- ---- .. ' .._-[11 Name of StCltP/llnion Tcr ritory MARVANA

- -----IV Nature of Election

(Please mention whether GeneralSTATE A8S ~I Election to State Assembly / Lok

I-V- .5abh~BJ:'e_~_lectio~J ---Date of declaration of result 19 - 10 - ::2014

-- ---VI Name and Address of the Election KULDE fP S.IN-- AgentVII If candidate is set up by a political

party, Please mention the name of the e. JQ P.political pa~

VIII Whether the party is a recognised Yes/~politicalQ?rtl

---------------1

IY'JBL'j

• ...J

Date: Signature of the Candidate

Place: Name

Amt. Amt. Amt.Incurred Incurred/ Incurred/ Auth. by authorize /Candidate d by Po!. authorize/ Election Party d byagent(in (in Rs.) othersRs.) (in Rs.)3 4 5--- ..- -

- q4:t7~ -

Total Election expenditure

PART-I!: ABSTRACT OF STATEMeNT OF ELECTION EXPENDITURE OF CANDIDATE

S. No_ Particulars

(3)+:4)+(5)

~--~~-------------------_+~~--~----~~~L-_+~---------------~~----71~2------~----~--------~----~ ~----+-~6-- ----~.!' Expenses in public meeting, rally, procession

elC:-_;I: Expenses in public meeting, rally,procession etc. (ie: other than the ones withStar Campaigners of the Political party(Enclose as per Schedule-L)1--__ ~"'--------'-.JL.:...:....::...::.'--'--'-'~c:....::.L-------_+----~+_---_+__----+--- .. -!

11. b Expenditure in public meeting rally, +orocession etc. with the Star Campaigner(s) (ie: _ 343 6.~o '4.,--' S"2.P _

lO:-hel than those for general party propaganda)f----- (Enclose as per Schedule~_:_--_:_ __ :__+_----_i11 Campaign materials other than those used in the 56'41:2 :19~~73 3T,-~-ljgs-

'-- __ -"-:.::.r.au=-:b:.:l:.::ic..::m:.:.:e:..:e:.:;ti:.:.:llco.g"!....:r..:::a.:.:llyL!.,,.l:p:.:..Jr.::..oc:.::e:::s::::.si:::..on::..::.et:::c.:..:.m:.:::::cn:.:.:t:.:..:io:..:.n:::cc=.d_..L.L- .-L. -L _ -I

443

Page 2: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

PART Ill: ABSTRACT OF SOURCE OF FUNDS RAISED BY CANDIDATE1--'--- ,---------.-- ..----.-------------.--.- .- ....---- ...----.-.-.--,-:----:-:---=--~---~o Particulars ._. . . . ..._ Amount (in Rs.)r-J-. 2 __ . . .. 3

I Amount of own fund used for the election campaign. ._~.ncl~se as per Schedule - 7) _11 Lump sum amount received from the party (ies) in cash or cheque ete.

(Enclose as per Schedl.::l:l.:::.e_-.::..8)'__ ~ _Lump sum amount received from any person/ company / firm/ associations / body ofpersons etc. as loan, gift or donation etc.(Enclose as per Schedule -9)r~----~~~~~~~~-~~~-'-------------------------;_---~~-~~----Total I '1.56 0 get

N()'f8 !.-DI F-F. 01 ~~ ~

wht'ch ,~

~j"s.U .

I1I

J ~ 10 &~

J3J~ ooo

as

Page 3: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

- 1 to 9: Details of EJections Funds and Expenditure of Candidate ------ ~~=-1~~~------

ra Ill' procession etc (le' other than those 1'1'1th :,UI \'.11"111I.' 1('1' e, < lJ I I he' p, d It j. ,11 I'dll Y)

---------_ .._----_.- --_._._--p"hllr'mrrring- - J ..-- - --.---- ----

ature of Expenditure Total Amount Source of Expenditurein R<; __ ·0" ___ ---

!\rnt. incurred I Arnt. Arnt, incurredAuth. by Candidate incurred / by othersI agent by Fol.

Party withnarr e

--.- ... -- ._--_ ..._'--- ._---.

) 2 :I 4 c; f>-- -----. .- --." _ ..-.•.....__ .._-

760ca 16000 -1 Vehicles for transporting visitors ~-- --- ..._- ...---.•.. ... - ...._- ---------

! ErprtinE StriEP, Prinnill 8>.Furniture, Fixture-s. poles etc. r' - r: ---

3 Arches & Barricades etc.~ ,...

r> ~.--._...

4 Flowers/ garlands c-- ~ -.-~---

f--_.. . -- ._--Hillllg Loud srf';Jkp.r~, Microphone, amplifiers, r> .r -

r-:cornparers etc.

6 Posters, hand bills, pamphlets, Banners, Cut-outs, -'--, ~ or- -rhoardings

.7 Beverages like tea, Water, cold drink. Juice etc . r- .-:-r- ---.-- -_ .._._-

8 Digital TV -bcards display, Projector display, tickers ,.-, - ..-boards, 3D display

~..._-

9 Expenses on celebrities, payment to musicians, other .- .-- ,....artists remuneration etc.

•.

10 Illumination items like serial lights, boards: cte. - ~ ,-r

11 E.~l'e,,~e~UII II auxpurL HelicoJlLer,! aircraft I veliicif'sl r,.-..boats elL. dldl ge!>( fUI self. celelnity or allY other r r

campaigner other than Star Campaigner)--

12 Power consumption/ generator charges e-:r- -..--

,13 Rent for venue .---- r- r- -e-

..14 Guards & security charges ~ ,,-,- -~ Boarding & lodging expenses of self, celebrity, partyIfunctionary or any other campaigner including Star ~ .r- ~~

Campaigner

16 Others expenses tl6 ~7 ~I

1&~7,;t r:._-_...... ,.._-_ ....... .- ..-Total 94J..7;t 9~.:I7.:1.~=_j~

Schedule- 2

Expenditure in public meeting rally, procession etc. with the Star Campaigner(s) as apportioned to candidate (ie: other than thOSC,Jfor general party propaganda)

<.'

447

Page 4: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

.'.'

.._._----') N·· [l"l., dllfi \I"IIUt' Na n re urL"e Sl ar CIIIII'digIJ'"' (,,);';' Aurount uf Expelldilul" UI, :-_

Name of Party !,Jruce:;:,iull elL, will I Llle Sapportioned to the candidate (A:,general party propaganda) in Rs.

1 2 3 4·

1..,_.

2 As Pr;1( A I U/(E A TT/} ('1-1;:f)3

4 II -Total

Schedule-3

Details of expenditure on campaign materials, like handbills, pamphlets, posters, hoardings, banners, cut-outs, gates & archVideo and audio cassettes, LDsI DVDs, Loud speakers, amplifiers, digital TV I board display, 3 D display etc. for candidate'selection campaign ( ie: other than those covered in Schedule- 1 & 2)

S, No, Nature of Expenses Total Amount in Sources of Expenditure Remarks, ifRs.

Amt. By Amt. By Pol. Amt. By otherscandidate I Partyagent

1 2 3 4 5 6 7

1 t:OUDSf'£Ak £AS ';"1,J1ooo c;:-<~/~ou-o C'

2 POSTGI< ) STI C «s«, (VJATlf{ 116 ggS 5'6 lil,;} 60'-173 r-

3 Co rr'JPA)G,A) Ml1r£~I~ J76'00 ~ /'760"0 r=,

4 rTotal , 3~648~ S(; 41 ~ ~9()f)73 ,.-

-Schedule- 4 ,Details of expenditure on campaign through print and electronic media including cable network, bulk SMS or internet or sociamedia etc. for candidate

S, No Nature of Name and address of Name and address of agency, Total Amount Sources of Expendituremedium media provider (print reporter, stringer, company or in Rs,(electronic I /electronic Isms I any person to whom charges I Amt. By Arnt. By ,;,print) and voice] cable TV, social commission etc. paid/ payable, candldate Z Pol.Party

duration media etc.) ifany agentCol. (3) +(4)

1 2 3 4 5 6. 7 Is1 EL~C'rl?oNlj SfYJ~ YOGI 9N P-OCOM 46~DO - 46~(}O2 -Do- 'VOIC e lADIO MANT,f/l 3~ 86S""' - ~~~h(3 PRINT N£uJS!JAPtR 3:1 76 7.S -- iAnll~- '1

C2,~J" ~4 I

..•..".'.

448

Page 5: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

1 2~

1

2

3

4

Total

-.----.-~--- '---,- - - I

I --~[Cr____ --'-1__4_0_7_()4_0--L_~_JitV 70 t. I..-

l~s_C_h_e_d_ul_e_~_s--", . . . . __

Details of expenditure on campaign vehicle (s) and poll expenditure on vehicle(s) for candidate's election campaign

Hiring Charges of vehicle Source of ExpenditureNo.of Days Total arnt.for which incurred/--.-1-"'------1 used auth. in Rs. !----~---- ---Fuel charges Driver's Amt. By AmI.By Pal

(If not covered charges candidate/ Partyunder hiri ng) I (If not agent

covered

{

under

. _..... )_ll_r_Jn_g_)__ +- -t -+ .__ ~- ..- I 3-c 4 5 6 .17----- ~

'---'r--' -----l------- -.-. r-f--t------f-----i------- ..-T-- --c-------.~1----+------+------+---{+s.----.2£1. AIJN'r'KilJR;: A rrr//()1'rn . _

f----t----:---1---+--.~ ...-+------1f-----t-----t-----+-----_ ..--=

S.No Regn.No.ofVehicle&Type ofVehicle Rate for

Hiring ofvehicle /maintenance

3a 3b

I-- ..l- ..l- ...L _

Schedule- 6f_------------------ ..-.------------------------ ..-.---.--Details of expenditure on Campaign workers / agents

S. 0 Date and Expenses on Campaign workers Total amt Sources of Expenditureincurred/ auth.

No.Ofworkers / In Rs. Amt.l3yagents candidate/

agentI---+----!-----------+---~------+--'-c-----_t_-----+---- ..-... - - ..-

~:mp';gn workers 3b l' 6 <>illro 7 8 _ f-~bcuurarturn/ salary 0 gatrO jetc.

r2--f----+B-o-a-r-d-in-g------+---~-----~I-------r-----~f------ I _._==3_-f +'-Lo_d...::g:....in:....g:...-.-t- ._..I-.-------+------t----~-_+_---.-- --1

f-~·-+T-:-O-ta-I_....L0_t_h~-rs-----'--- '------t---~-~-~-~:3=~-'~1-......L+_-__'-:~..!....'~-~:6='1=:="=;_~~Q770~L -Schedule- 7

Venue Nature of Expenses Qty, Amt.By Pal.Party

Arnt. Byothers

2

1

Details ofAmount of own fund used for the election campaign ----r~--- '''~-~=~~-='1S.No. IDate Icas.h. I DDI Cheque no. etc. with details of Total Amount in Rs. IRemarksI __Ld_r_a_w_e_e_b_a_n_k --'- --'I. ----.l

449..•.-s

Page 6: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

,.

.,

'.

..-.--.-..-..-.,-------1..-.1 12 ,J

I-- ..-.... i -..-".-"'-'--..--.+--- r~'.1~~. ..CllS H-----~~~lCASH3e---__ _ _

4'---, ---. -.-..- -..- -..---.- --_.__._-._-------_._---1---._--------Tolal 165r.roTJr-------.L-:-----.-----.--'-----~_._L .....__J

-- T--··-------·" _ .. - -_... - --.----------- ~----- -

- -- J~--.-------.-----------. -~..---....-.--.-.- lurrrro ,--.- -_._ .. ----------_._----- -"--------- ISSw-o.--- -- -_._-_.__ ._--_.__._------_ ....- - _._-_ ..__ ._---_.- '--

-_.- ---_._--- -_._--_ .._- - ----_._-_._--_._---

Schedule- 8(----------------_._------------------------ -_ .•.-Details of Lump sum amount received from the party (ies) in cash or cheque or DD or by Account Transfer

S:No. Name of the Political Party fD-:~'~---- Cash 00/ Cheque no. etc. V::iili T~l<JA~~~;un; ~ 'TR;marks, Ift3 details of drawee bank Rs. Iany

: 2RHARnA mN7APA;;l~:~~4 (.Al 5 _. 7~~,~~2 -.olo ----==-__ ..j 9lt~Jo=-!.j - ct~' ~~;C/JE.L ': -=-~="-1;;:::: ~:~ 1~(~~+~~

Totai 13,.I!~vvv--t---l1-----'---------.--.- ..----.-.-....---- .--...---~----~Schedule- 9~---~-----------.-- ._ .._---------------------------_._- -------_ .._------'Detailsof Lump sum amount received from any person/company /firm/associations/body of persons etc. as loan. gift or donationete.

S. Name and address Date --·--·---cas~~-C-h-eq-l;;~-O-.-r-M-e-l-lt-io-n------.-T-O-t~I~;~;;~I~~- i~ '\fj1ern-a-r-k-s--:

No. . I:~C.with details whether loan. R,

1 2 3 4 :' drawee bank ::~" donation 7 . ,k----1--1 -+----1----+----=------Ir----t----t------------+.-----:2 II---f-------+-------+--------+-------+-------+---.-- -·---·1-------:t-3_-+ -I- +- -+ +- -c-+- --i--------:1-

4--+-------'--'-------1IC--------+------+------+--------·-·--·i------

'--_-1-T_o_ta_l -'-. ..l.- __ --'- __ .....J... --'- . ._L _

Note: .1. In Schedule 5:-(a) copy of the order containing list of all vehicles for which permit issued by the Returning Officer to be enclosed.Cb) If the vehicle is owned by the candidate/his relative/agent are used for election purpose, notional cost 01 hire ofall such vehicles, except one vehicle if owned and used by the candidate, notional cost of fuel and drivers SJI:<ry forsuch vehicle, shall ·ne included in total amount of expenditure in the above table.

450

Page 7: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

-SCHEDULE-2

EXP. IN PUBLIC MEETING, RALLY, PROCESSION ETC. WITH THE STAR CAMPAIGNER(S)

SR. NO.. NAME OF STAR CAMPAIGNERS &

DATE VENUE AMOUNT OF REMARKSNAME OF PARTY

EXPENDITURE

1 26-09-2014 GHARAUNDA MANOJ SINHA RAILWAY RAJYAMA 208602 04-10-2014 KARNAL PRIMEMINISTER SH. NARENDER M 91930 APPORTIONED3 07-10-2014 BARSAT SMT. SUSHMA SWARAJ 1985844 10-10-2014 GAGSINA SH. SANJEEVBALYAN 686005 12-10-2014 ARAINPURA V.K. SINGH 620686 13-10-2014 KOHAND KRISHAN PALGUJJAR 43108

TOTAL 485150

•..

~\.AI-i

Page 8: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

SCHEDULE-SDETAIL OF EXPENDITUREON COMPAIGN VEHICLESAND POLL EXPENDITUREON VEHICLESFORCANDIDATES ELECTIONCOMPAIGN

-,j>

iHIRING CHARGESOF VEHICLE TOTAL SOURCEOF EXPENDITURE

NO. OF DAYS AMOUNTSR, NO. REGN. NO.

USED INCUREED/AUTH AMT.BY AMT. BY AMT. OTHERS

RATE FUELCHARGES DRIVERSCHARGES CANDATE/AGENT POL. PARTY- --- -~ - -- -------

1 UP.81 AF 8400 ~ 2,000.00 20 ~40,000.OO ~ 40,000.00

2 HR45B 8747 ~ 2,000.00 18 ~ 36,000.00 ~ 36,000.00

3 HR45 A 8478 ~ 2,000.00 18 ~ 36,000.00 ~ 36,000.00

4 HR45A 3471 ~ 2,000.00 3 ~ 6,000.00 ~ 6,000.00

5 HR 58 9766 ~ 2,000.00 3 ~ 6,000.00 ~ 6,000.00

6 HR458167 ~ 2,000.00 3 ~ 6,000.00 ~ 6,000.00

7 HR45A 4506 ~ 2,000.00 3 ~ 6,000.00 ~ 6,000.00

8 HR45B 2806 ~ 1,600.00 15 ~ 24,000.00 ~ 24,000.00

9 HR45B 3581 ~ 2,000.00 FUELCHARGESIS DRIVERCHARGES IS 15 ~ 30,000.00 ~ 30,000.0010 HR 65 7408 ~ 2,000.00 INCLUDING IN INCLUDING IN 15 ~ 30,000.00 ~ 30,000.0011 HR 58A 4857 ~ 2,000.00 HIRING CHARGES HIRING CHARGES 15 ~ 30,000.00 ~ 30,000.0012 HR 05 AL 9037 ~ 2,000.00 14 ~ 28,000.00 ~ 28,000.0013 HR45 A 2018 ~ 2,000.00 4 ~ 8,000.00 ~ 8,000.0014 HR 45S 4521 ~ 2,000.00 4 ~ 8,000.00 '!; 8,000.0015 HR 45 B 1162 ~ 2,000.00 4 ~ 8,000.00 ~ 8,000.00

16 HR 45A 2827 ~ 2,000.00 4 ~ 8,000.00 ~ 8,000.00

17 HR 05V 0999 ~ 2,000.00 1 ~ 2,000.00 ~ 2,000.00

18 HR05AK 5955 ~ 2,000.00 1 ~ 2,000.00 ~ 2,000.00

19 HR26BB0502 ~ 2,000.00 1 ~ 2,000.00 ~ 2,000.00TOTAL 316000 316000

~

Page 9: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

~~..

HARYANA312

3e=ore6 the Distt.FORM OF AFFIDAVITElecton officer (Karnal (District,

S-ate/Union Territory.S Affiavit of Sh. Harvinder Kalyan son of Sh. Devi

S~ngh ion of Sh. Munshi Ram Kalyan aged 47 years resident0= VPO Kutail, Tehsil and Distt. Karnal do hereby solemnly

~and sincerely state and declare as under :1. T~at r was contesting candidate at the General Election

t1 the House of the People/Legislative Assembly ofHaryana from 22-Gharaunda Parlimentary/Assemblycinstitutency, the result of which was declared on19.10.2014.

2. Tlat Lz my election agent kept a separate and correctifcount of all expenditure incurred / authorised by me/ my election agent in- connection with the above£ection between 26.09.2014 (the date on which 1 was1ominated) and the date of declaration of the resultthereof, both6

NU I ZU It-

Page 10: PART - I -' Name AR-Vif·rlJi?~ o-~,;l G7HrA~lIu D · -1to 9: Details of EJections Funds and Expenditure of Candidate----- ~~=-1 raIll' procession etc (le' other than those 1'1'1th:,UI

::..That the said account was maintained In the Registerfurnished by' the Returning Officer for the purpose andthe said Register itself is annexed hereto with thesupporting vouchers/bills mentioned in the said

-account,4. That the account of my election expenditure as annexed

hereto includes all items of election 'expenditureincurred or authorised by me or by my election agent,the political party which sponsored me, otherassociations / body of persons and other individualssupporting me, in connection with the election, andnothing has been concealed or withheld/suppressedther'e f rom (other than 'the"expense on travel of leaders I

covered by Explanations 1 and 2 under section 77 (1) ofthe Representation of the People Act, 1951),.

5.That the Abstract Statement of Election Expensesannexed as Annexure 11 to the said account alsoincludes all expenditure incurred o~ authorised by me,my election agent, the political party which sponsoredme, other associations / body of persons and otherindividuals supporting me,election.

in connedtion with the

6.That the statements in the foregoing paragraphs (1) to(5) are true to the best.'of'·my knowledge and belief,that nothing is false and nothing material has beenconcealed.

~V\~~

DeponentkAR.NAI.. this day of

,, .1·

I :z.II. I LtSolemnly affirmed/ sworn by J1ItRVJN.bt:..~at

k.(:}..1- 'IPt N.before me.

and seal of the Attesting authority, i. e.

of t~~rf~~;.rEt~:i~qJ;g.S,$::::::or"ORh Commission or Notary(i~~(:12LrE:;d i: '~r;:'::'r~>'~';:J~~!:'(ir~:~~~Ut;);)

t-iC"--", "',". at ·/,-.:-~:...l l-,'Y theJJ,',,! '.t"'_~ .!' '-Cl. . :....1 •.•• H ~

d<f:~PG~';(::n~:. ~c:1.~~.....~~h~c(.jtit1edby

NOV 20 4