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I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this 6th day of Jan. , 20 23 <br />(Firm) <br />Si2n&re of Contractor/Bidder or Its <br />Maria Dahlmann, Secretary/Treasurer <br />Printed Name and Title <br />Subscribed and sworn to before me this 6th <br />day of Jan. , 2023 <br />My Commission Expires April 21, 2(}�O <br />Q&J�267,1PA'. - <br />Notary Public <br />++"""". DE130RAH R COOPER County of Residence <br />Madison <br />10?..••. 9�'; Notary Public, State of Indiana <br />=z'S1 AL;"= Madison County <br />Commission Number NP0740102 <br />My Commission Expires <br />u,,,,,,,+e April 21, 2030 <br />