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    STATE OF CALIFORNIA

    FRANCHISE TAX BOARD9750 BUSINESS PARK DRIVE, SUITE 214

    SACRAMENTO, CALIFORNIA 95827-1702

    In reply refer to347:APP:PTS:dh:g

    History of Mining1969 West Clemson street

    San Bernardino. CA 92407

    Purpose

    Form of OrganizationAccounting Period Ending:

    Organization Number

    Educational

    Corporation

    December 31

    On the basis of the information submitted and provided your present

    operations continue unchanged or conform to those proposed in your

    application. you are exempt from state franchise or income tax underSection 23701d. Revenue and Taxation Code. Any change in operation.

    character or purpose of the organization must be reported immediately,to this office so that we may determine the effect on your exempt

    status. Any change of name or address also must be reported.

    You are required to file Form 199 (Exempt Organization Annual

    Information Return) or Form 199B (Exempt Organization Annual

    Information Statement) on or before the 15th day of the 5th month (4

    1/2 months) after the close of your accounting period. See annual

    instructions with forms for requirements.

    You are not required to file state franchise or income tax returns

    unless you have income subject to the unrelated business income taxunder Section 23731 of the Code. In this event. you are required to

    file Form 109 (Exempt Organization Business Income Tax Return) by the

    15th day of the 5th month (4 1/2 months) after the close of yourannual accounting period.

    If the organization is incorporating. this approval will expire unless

    incorporation is completed with the Secretary of State within 60 days.

    Exemption from federal income or other taxes and other state taxesrequires separate applications.

    Special Audit Section

    Telephorie (800) 852-5711

    cc: Russell D. Hartill

    Secretary of State

    Registrar of Charitable Trusts

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    , 1 6 1 5 5 3 6~ i"! fJ U to { ~ C t,1

    . l' ....l-" ;",. ~.~ ~,)

    in tho off;':" o! f . , . , Sccrct:JrY ef SlaIlIof tho Stale of Cohfornio

    . M A Y 2 7 1 9 8 8

    M A R C H F O N G 0 . S e e re t1 ry a t S fa tl

    ARTICLES OF INCORPORATION

    O F1 BE H IS TO RY O F M IN IN G

    ONE: The name of this corporation is the History of Mining.

    T WO : T hi s c or po ra ti on i s a no np ro fi t p ub li c b en ef it c or po ra ti on

    and is not organized for the private ~ain of any person. It is

    o rg an iz ed u nd er t he N on pr ofi t P ub li c B en ef it C or po ra tio n L aw f or

    ch ar it ab le p ur pos es . T he s pe ci fi c p ur po se s f or w hi ch t hi s

    I

    c or po ra ti on i s or ga ni ze d i s to e du ca te t he g en er al p ub li c in

    Ith e h is to ry , f ol klo re , t ec hn iq ue s a nd v al ues t o s o ci et y of o ur

    m in in g h er it ag e. T he m ean s o f pr ov id in g s uc h e du ca ti on i nc lu de s

    b ut i s no t l im it ed t o t h e d is se mi na tio n o f e du ca ti on al m at er ia l

    i n t he p ub li c i nt er es t t hr ou gh p ubl ic at io ns , l ec tu re s a nd

    re en ac tm ent s; t ra in in g o f vo lun te er s i n t ec hn iqu es o f so un d

    o f f ac il it ie s f or t he r es ea re h a nd s tu dy o f mi ni ng h is to ry .

    THREE: The name and address in the State of California of this

    FOUR:

    ( a) T hi s c or po rat io n is o rg an iz ed a nd o pe rat ed e xc lu si ve ly f or

    ed uc at io nal p ur po se s w ith in t he m ea ni ng o f S ec ti on 5 01 ( c) ( ))

    o f t he I nte rn al R ev en ue C od e.

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    (b) Notwithstanding any other provision of these Articles, the

    corporation shall not carryon any other activities not permitted

    t o b e c ar ri ed o n ( 1) b y a c or po ra ti on e xe mp t f ro m f ed er al i nc om e'

    t ax u nd er S ec ti on 5 01 (c )( 3) o f t he I nt er na l R ev en ue C od e o r ( 2) b y

    - a corporation contributions to which are deductible under Section

    170(c)(2) of the Internal Revenue Code.

    (c) No substantial part of the activities of this corporation

    shall consist of carrying on propaganda, or otherwise attempting

    to influence legislation, and the corporation shall not participate

    or intervene in any political campaign (including the publishing

    or distribution of statements) on behalf of any candidate for

    public office.

    F IV E: T he n am es a nd a dd re ss es o f t he p er so ns a pp oi nt ed t o a ct a s

    the initial Directors of this corporation are:

    Name Address

    Ru ss el l D . H ar ti ll 1 96 9 W . C le mso n S t., Sa n Ber na rdi no C A 9 24 07Ro be rt K. Ho shi de 7 51 J Sa us al ito Av en ue, C an oga P ar k C A 91 30 7Stephen Ryland 2400 E. Foothill Blvd., Pasadena CA 91107Emmett C . Harder 18 02 1 Muriel Avenue, San Bernardino CA 9 2407Brian A. Beck 2855 Pullman st., Santa Ana, CA 92705

    SIX: The property of this corporation is irrevocably dedicated

    t o e d uc at io na l p ur po se s a nd n o p ar t o f t he n et i nc om e o r a ss et s o f

    the organization shall ever inure to the benefit of any Director,

    o ff ic er , o r m em be r t he re of o r t o t he b en ef it o f a ny p ri va te p er so n

    On the dissolution or winding up of the corporation, its assets

    remaining after payment of, or provision for paYment of, all debts

    and liabilities of this corporation, shall be distributed to a..:.

    nonprofit fund, foun~ation, or corporation which is organized andoperated exclusively for educational purposes meeting the

    requirements of Section 214 of the California Revenue and

    Taxation Code and which has established its tax-exempt status

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    under Section 501{c){J) of

    April 10th, 1986.

    the Internal Revenue Code.

    ~PJU_Russell D. Hartill, Director

    rAq-~~Robert K. Hoshide, Director

    ~-- iJ2~~

    Q~~~Emmett c. Har~DireCtOr

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    B y la w s o f Cl.--'the Living W e ! t " " " " "

    A C a l i f o rn i a N o n pr o f it P u b li c B e ne f i t C o r po r a ti o n .

    T h e p r in c ip a l o f fi c e o f t h e c o rp o ra t io n f o r t h e t r an s ac t io n o f i t s b u si n es s

    i s l o ca t ed i n L o s A n ge l es C o un t y~ C al i fo r ni a .

    T h e c o un t y o f t h e c o r p or a ti on ' s p r in c ip a l O f fi ( fa c a n b e c h an g ed o n ly b y ~a mm en dm en t o f t h es e B yl aw s a nd n o t o t he rw is e. e B o ar d o f D ir ec to rs m a~ ~h o we v er ~ c h an g e t h e p ri n ci p al o f fi c e f r om o n e o c at i on t o a no t he r w i th i n t h en a me d c o un t y b y n o t in g t h e c h an g ed a d dr e ss a n d e f fe c ti v e d a te d e lo w ~ a n d s u chc h an g es o f a d dr e ss s h al l n o t b e d e em e d a n a m m e nd m en t o f t h es e B yl a ws :

    c h a n g e / d a t ec h a n g e / d a t ec h a n g e / d a t e

    T h e c o r po r at i on m a y a l s o h a ve o f fi c es a t s u c h o t he r p l ac e s~ w i th i n o r w i th o utt h e S t at e o f C a li f or n ia ~ w h er e i t i s qu a li f ie d t o d o b u si n es s ~ a s i t sb u si n es s m a y r e q ui r e a n d a s t h e B oa r d o f D i re c to r s m a y~ f r om t i me t o t i m e ~designate.

    A r t ic l e 2 . P U R PO S ES

    S e c t i o n 1. O b j ec t i ve s a n d P u r po s e s tjo l:Q.u,.e.lp{'(J~

    T h e p r i m a r y o b j ec t i ve ~ a n Q Q u r p o se s pf t h i s c o r po r a ti o n s h a lL h b ~: ~~~ft~~~~ ~-~t'r P{~7{Vt_ 4!t1UCG{I:r a.c~vt3l:fO.

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    f,. Pranote the developnent and use of living history (tS 0- VYlDQ Moj- /a:-.miVl$ ctlco.:Jf"ou'

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    rthe Boa.rdof Directors as specif:i;qedsuccessor is elected and qualifie'S'.

    Section 5. Canpensation

    Directors shall serve without canpensation except that they shall be allowedand paid their actual and necessary expenses incurred in atterrling Directors

    ~ meetings. In addition, they shall be aliCMedreasonable advsncementorreimbursement for expenses incurred in the Perfonnance of their regular

    duties as specificed in Section 3 of this Article. Directors maynot becanPenSated for rendering services to the COrPOrationin any capacity otherthan Director unless such other canPenSation is reasonable and is allowableunder the provisions of Section 6 of this Article.

    Section 6. Restriction regarding Interested Directorsq . s , ;

    Notwithstanding any other provision of thtes Bylaws, not morethan forty-ninePercent (49%) of the Persons serving on the Boa.rdmaybe interested Persons.For purposes of this Section, "interested Persons" meanseither:

    a) any Person currently being canPenSatedby the COrPOrationfor servicesrendered it within the previous twelve (12) months, whether as a full- or

    part-time officer or errployee, indePerrient contractor, or otherwise,excluding any reasonable canPenSation paid to a Director as Director; or

    b) any brother, sister, ancestor, descerrlant, spouse, brother-in-law,sister-in-law, son-in-law, daughter-in-law, mother-in-law, or father-in-lawof any such Person.

    Meetings shall ~ held at the principal office of the COrPOrationunlessotherwise provide~by the Board or at such place within or without the Stateof California which has been designated fran time to time by resolution ofthe Board of Directors. In the absence of such designation, any meeting not

    held at the principal office of the COrPOrationshall be valid only if heldon the written consent of all Directors given either before or after themeeting and filed with the Secretary of the COrPOrationor after all Boardmembershave been given written notice of the meeting as hereinafter providedfor special meetings of the Board. Anymeeeting, regular or special, maybeheld by conference teleP'lone or similar cx:mnunicationsequipnent, so long asall Directors participating in such meeting can cx:mnunicatewith one another.

    Regular meetings of Directors shall be held on the first mondayof the nonthat 7 pn unless such day falls on a legal holiday, in which event the regularmeeting shall be held at the samehour and place on the next rosiness day.

    At the annual regular meeting of Directors for the monthof September,Direc!=9rsshall be elected by the Board of Directors Cumulativevoting forthe eqlection of Directors shall not be pennitted. the candidates receivingthe highest mnnberof votes up to the numberof Directors to be elected shallbe elected. each Director shall cast one vote, with voting being by ballotonly. ;.

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    Section 9. Special meetings

    Special meetings of the Boardof Directors maybe called by the Chairmanofthe Board, the President, the Vice-President, the Secretary, or by any twoDirectors, and such meetings shall be held at the place, within or withoutthe State of California, designated by the person or persons calling themeeting, and in the absence of such designation, at the principal office ofthe corporation.

    Regular meetings of the Boardmaybe held without notice. Special meetings ofthe Board shall be held uponfour (4) days' notice by first-class mail orforty-eight (48J,hours' notice delivered personally or by telrE0ne ortelegraph or e:I,.ctronicmail. If sent by mail or telegram or e tronic mail,the notice shall be deemedto be delivered on its deposit in e mails or onits delivery to the telegraph or canputer canpany. Suchnotices shall beaddressed to each Director at his or her address as shownon the books of thecorporation. Notice of the time and place of holding an adjourned meetingneed not be given to absent Directors if the time and place of such adjournedmeeting are fixed at the meeting adjourned and if such adjourned meeting is

    held no ll'K)~ethan twenty-four (24) hours fran the time of the originalmeeting. Notice shall be given of any adjourned regular or special meeting)0proceedings shall be provid~ this corporation rot only to the extent \ allCMedby, and in accordance with the requirements of, Section 5238of the

    California Nonprofit Public Benefit Corporation Law.

    TheBoard of Directors mayadopt a resolution authorizing the PUrchaseandmaintenanceof insurance on behalf of any agent of the corporataion(including a Director, officer, employeeor other agent of the corporation)against any liability other than for violating provisions of law relating toself-dealing (Section 5233of the California Nonprofit Public BenefitCorporation Law)asserted against or incurred by the agent in such capacity

    or arising out of the agent's status as such, whether or not the corporationwouldhave the p:JWer to indamify the agent against such liabilty under theprovisions of Section 5238of the California Nonprofit Public BenefitCorporation Law.

    The officers of this oorporation shall be a President, a Secretary and chieffinancial officer whoshall be designated the Treasurer. The Corporation mayalso have, as detennined by the Boardof Directors, a Chainnanof the Board,

    one or moreVice-Presidents, Assistant Secretaries, Assistant Treasurers, orother officers. Anynumberof offices maybe held by the same~son exceptthat neither the Secretary nor the Treasurer mayserve as the Peident or )UChainnanof the Board. ~

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    Anyperson mayserve as officer of this corporation. Officers shall beelected by the Boardof Directors, at any time, and each officer shall holdoffice until he or she resigns or is removedor is otherwise disqualified toserve, or until his or her successor shall be elected and qualified,whichever occurs first.

    8

    TheBoardof Directors mayaPIX>intsuch other officers or agents as it may

    deemdesirable, and such officers shall serve such tenns, have suchauthori ty, and perfonn such duties as maybe prescribed fran time to time bythe Board of Directors.

    Anyofficer maybe reooved, either with or without cause, by the BoardofDirectors, at any time. Anyofficer mayresign at any time by giving writtennotice to the Boardof Directors or to the President or Secretary of thecorporation. Anysuch resignation shall take effect at the date of thereceipt of such notice or at a later date SPeCified therein, and, unlessotherwise SPeCified therein, the acceptance of such resignation shall not benecessary to makeit effective. The above provisions of this Section shall be

    superseded by any conflicting tenns of a contract which has been approved orratified by the Boardof Directors relating to the enploymentof any officerof the COrPOration.

    Anyvacancies caused by the death, resignation, reooval, disqualification, orotherwise, of any officer shall be filled by the Boardof Directors. In theevent of a vacancy in any office other than that of President, such vacancymaybe filled tenporarily by aPIX>intmentby the President until such time asthe Board shall fill the vacancy. Vacancies occuring in offices or officersaPIX>intedat the discretion of the Boardmayor maynot be filled as theBoard shall detennine.

    The President shall be the chief executive officer of the corporation andshall, subject to the control of the Boardof Directors, SUPerViseandcontrol the af:tairs of the COrPOrationand the activities of the officers. He

    '{J or she Sha~l ~fonn all duties incident to his or her office and such otheri ~ duties as be required by law, by the Articles of Incorporation of this

    corporation or by these Bylaws, or whichmaybe prescribed fran time to timeby the Board of Directors. Unless another person is specifically aPIX>intedasOlainnan of the Boardof Directors, he or she shall preside at all meetingsof the Boardo~' ors. If applicable, the President shall preside at all

    (\) meetings of th BoD.If applicable, the President shall preside at allmeetings of the s. Except as otherwise expressly provided by law, bythe Articles of Incorporation, or by these Bylaws, he or she shall, in thenameof the corporation, execute such deeds, rrortgages, bonds, contracts," " ' ; r ' s, or other instruments which fran time to time be authorized by the

    t,::' ~ BoD\ "'.

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    Anyperson mayserve as officer of this corporation. Officers shall beelected by the Boardof Directors, at any time, and each officer shall holdoff ice until he or she resigns or is rerrovedor is otherwise disqualified toserve, or until his or her successor shall be elected and qualified,whichever occurs first.

    TheBoard of Directors mayappoint such other officers or agents as it may

    deemdesirable, and such officers shall serve such tenns, have suchauthori ty, and perfo:rmsuch duties as maybe prescribed fran time to time bythe Board of Directors.

    Anyofficer maybe rerroved, either with or without cause, by the Board ofDirectors, at any time. Anyofficer mayresign at any time by giving writtennotice to the Boardof Directors or to the President or Secretary of theoorporation. Anysuch resignation shall take effect at the date of thereceipt of such notice or at a later date SPeCified therein, and, unlessotherwise SPeCified therein, the acceptance of such resignation shall not benecessary to makeit effective. The above provisions of this Section shall be

    superseded by any conflicting tenns of a contract which has been approved orratified by the Board of Directors relating to the employmentof any officerof the oorporation.

    Anyvacancies caused by the death, resignation, rerroval, disqualification, orotherwise, of any officer shall be filled by the Boardof Directors. In theevent of a vacancy in any office other than that of President, such vacancymaybe filled temporarily by appoinbnent by the President until such time asthe Board shall fill the vacancy. Vacancies occuring in offices or officersappointed at the discretion of the Boardmayor maynot be filled as theBoardshall detennine.

    The President shall be the chief executive officer of the corporation andshall, subject to the control of the Boardof Directors, SUPerviseandoontrol the aft'airs of the oorporation and the activities of the officers. He

    '{J or she sha~l ~fonn all duties incident to his or her office and such other{-(J duties as be required by law, by the Articles of Incorporation of this

    I oorporation or by these Bylaws, or whichmaybe prescribed fran time to timeby the Board of Directors. Unless another person is specifically appointed asOlainnan of the Boardof Directors, he or she shall preside at all meetingsof the Boardo~' ors. If applicable, the President shall preside at all

    (\) meetings of th BoD.If applicable, the President shall preside at allmeetings of the s. Except as otherwise expressly provided by law, bythe Articles of Incorporation, or by these Bylaws, he or she shall, in thenameof the corporation, execute such deeds, rrortgages, bonds, oontracts,

    " ,,~s, or other instruments which fran time to time be authorized by the,~,~~Bd)j\ "-\

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    rIn the absence of the President, or in the event or his or her inability orrefuse to act, the Vice-President shall perfonn all the duties of thePresident, and whenso acting shall have all the powersof, and be subject toall the restri~ons on, the President. TheVice-President shall have otherpowers and perf such other suties as maybe prescribed by law, by the

    ~cles of In ration, or by these Bylaws, or as maybe prescribed by the

    Section 8. Duties of secretary

    Certify and keep at the prii'nc'pa.l office of the oorporation or at such otherplaces as the Boardmayde 'ne, a book of minutes of all meetings of the /'-.Directors, and, if applicabI , ~~ings of cxmni. ttees of Directors and ofmembers,reoording therein the ti~ and place of holding, whether regular or : t . . r , J

    f Q h n \l ( t\ \ : f , rs n.'W>~ q~ut

    0ok~'5l,~Ct~Y 'i01O j_~

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    : J - w . Q . b e . . . , i"

    vnt~lJ--~

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    Department of the Treasury-Internal Revenue Service

    Consent Fixing Period of lim'itationUpon Assessment of Tax Under Section

    4940 of the Internal Revenue Code(See instruction 2 of Part IV-Form 1023 instructions.)

    To be used with

    1023. Submit

    duplicate.

    OMI No. 1545-005

    Expires M.y 31, 19

    Under section 6501(c)(4) of the Internal Revenue Code, and as part of a request filed with Form 1023

    the organization named below be treated as a publicly supported organization under section 170(b)(l)(A)(vi)

    section 509(a)(2) during an extended advance ruling period,

    o If the first tax year in the extended advance ruling period is at least 8 months long, then the periodassessing tax (imposed under section 4940 of the Code) for any of the 5 tax years in the extended

    vance ruling period will extend 8 years, 4 months, and 15 days beyond the end of the first tax yea

    o If the first tax year in the extended advance ruli ng period is less than 8 months long, then the periodassessing tax (imposed under section 4940 of the Code) for any of the 6 tax years in the extended

    vance ruling period will extend 9 years, 4 months, and 15 days beyond the end of the first tax yea

    However, if a notice of deficiency in tax for any of these years is sent to the organization before the perio

    pires, then the time for making an assessment wi II be further extended by the number of days the as

    ment is prohibited, plus 60 days.

    Signature ~

    District Director

    B y ~

    For Paperwork Reduction Act Notice, see page 1 of the Form 1023 instructions.

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    f / A * f '! I I s i " 'l a ~ t e ! M o " " t i ~ l t I @ s . , j ; f tlti J I W r ~ u i i l n ~ t l i i Q r I i l i Q M i 6 " , t . i A . . , . ; w ~ i p w i Q p . a 8 ~ Q W W i l Q t i 4 i 8 M " ! " , o to t l f t i e ' e"l!Iar'lldrttnlI'rlOT!ISrnmrrlflTi~6'LIaii'nccentTiheeoJJnuo;rf~~

    1 : h t : , T iv iNS West, a seIvlCe mgaii lzatiOII d ed i c a t e d to tlit dyliJiIIlC 1 I it e f p re t a n o n o rW'tWern American history.

    Its goals are to: . }41 S fO .VJ.-.J ~V~MIItll'~.s/ E ~\M"f"'S

    1 Arrange, orchestrate and conduct living history reenactments of selected topic)ff

    estern American history, demonstrations of old-time technological processes and

    trades, etc., at selected national parks, monuments and local and regional historic

    sites, landmarks and districts for member participation and public viewing.

    s~1\v 1 . Operate wesearch center for t

    history, geography and geology,

    the S tadY 3 ' ! ! ! I !0d S lepiio Ir~~~~Tt~ ~ Q"\./I',J, .

    . COiLl1trctb j g " bshzsd 5 3 surveys of historic sites for ~ariow~"lgenciesa~Bt ~ the cataloging, inventory J lf I I I 'I ! to . study, of historical values within their

    jurisdiction. \y'O IY'

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    "-~jSNi"--~Qj,.,.;.,,. IIJ'~

    ~ ijo3ti;OIews o~ n1fWIitJ. e~ .tUWlt I,lfiltie. nVt"l''''.,J dc#Ch~'WI o:r'''', M : J . . S~

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    . , , , . , .;jben V' "KIf ; .' " - " " < i ' 3

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    ~.,.-'~lJf;r;ilI~~ .1;irA~~tA-~J~, l

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    ,

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    Form 1023 (Rev. 7-81)

    Part ilL-Activities and Operational Information (Continued)

    8 6Have the recipients been required or will they be required to

    services, or products? . . . .. ..

    pay for the organization's benefits, ./

    . .. 0'Yes

    " + ~ ) : l ; : : : ae:~lain,~~~:hO: h~:7~~.;~c~a~~~.~~ d:n~\rmi~~d. [I,,, .W o~''* ~N""': Vi\~.lr "' ..f r:~,'sj.1' ~., ;)(~"'f'r ( v , C > t ( . ~ ' " OlY rmd;.~)

    9 2::..r will the organiza..tion limit .its benefits, services, or products to specific classes of individuals? .~' .";Pl14~it~ ,a '

    ben.fie'"',, 0'willbe "'ooted.

    10 Is the organization a membership organization? .

    If "Yes," complete the following:

    6~~~'be ~;,",;:,;n""m.;:;~;mt~~~X=~~~""!tf:t~ ~~ ~z. lPl"~~ ;Q l ,:~ /; ~ = . ~

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    SiVt~V I , . - i s-

    ,~~ $I ; ' ; w J is fl ,,, G)

    VII O c ) d r 1 t , . . " . . - !"iflttfAf I 1 J . ~ . " . . - . e _~.p.br obatlbAtL ~".$~t,., ~ / ~.JI'CIf:t'-oj- OUy JM.MS J f)Jtu~ f..tqVlftr h-tJJlf- r~M ak ~m ~b W S e. ~ ~ pubic. . O w ~ " " "

    t (

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    ~ ta t o f Q I a lr r n m i ac f f i 1 lnn : q J f l nug I t r u ~ a ~ r : ~ ; n ~ : 4 ~ ~ 094244-0230

    J5'c.cretu~ of J5'tutc PllOne (916) 445-2020

    STATEMENT BY DOMESTIC NONPROFIT CORPORATION

    THIS STATEMENT MUST BE FilED WITH

    CALIFORNIA SECRETARY OF STATE (SECTIONS 6210, 8210, 9660 CORPORATIONS CODE)

    C1615536 PB DUE DATE 05-31-91H I S TO R Y O F ~ I ~ I N G1 969 W. Cl EMS eNS T SAN BERNARDINO, CA 92407

    2. STREET ADDRESS OF PRINCIPAL OFFICE

    (IF NONE. COMPLETE 3-35) A

    J96q t[~J'i{C1:; ;nJ/)" jSi f f< i f IDO NOT USE P.O. BOX NO.)

    3. MAILING ADDRESS

    SUITE OR ROOM 2A.

    .~ !l:AvI}ll/J/f1jQ ell

    BUSINESS OR RESIDENCE ADDRESS IDO NOT USE P.O. BOX)

    GA.

    /969 [(). CkltJJCIV .Str~rJ

    4B. 4C.

    -~ ~f:/}I)tll/() C 4 92lJCCITY AND STATE ZIP CODE

    SB. SC.

    .~ ~.-IJ/fiJO C4 924CITY AND STATE ZIP CODE

    GB. GC.

    -~1tJfd,

    (lJ 92407' . - ' 1 \ / I} f)J j /f I 1J CITY AND STATE ZIP CODE

    BUSINESS OR RESIDENCE ADDRESS (DO NOT USE P.O. BOX)

    SA.

    Iq69 tu. (IP/J110 /1) .S;r{J.{lq-


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