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a <br />Company I® Number: 486671 <br />ly <br />any Se�LB <br />0 <br />To be accepted as a participant in E-Verify, you should only sign the Employer's Section <br />of the signature page. If you have any questions, contact E-Verify at 888-464-4218. <br />Employer Ziolko«ski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />Title <br />111 a12012 <br />Signature <br />Date <br />Depaitment of Homeland Security ®1lerification Division <br />SCIS Verification Division <br />Name (Please Typo or Print) <br />Electronically Signed <br />Title <br />01/10/2012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to yolur Company: <br />Company Name: <br />iolkowski Construction, Inc. <br />Address:14060 <br />Ralph Jones Dr. <br />-CompanyFacility <br />outh Send, IN 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />STJOSEPH <br />Employer Identification <br />Number: <br />361446992 <br />Page 12 of 13 1 E-Verify NOU for Employer I Revision Date 00/01/09 www.dhs.gov/E-Verify <br />