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Prescribed by the County Form 170 <br />State Board of Accounts r <br />(2005) <br />Declaration <br />This form is to be signed by the preparer of a document and recorded with each document in accordance <br />with IC 36-2-7.5-5(a). <br />I, the undersigned preparer of the attached document, in accordance with IC 36-2-7.5, do hereby affirm <br />under the penalties of perjury: <br />1. I have reviewed the attached document for the purpose of identifying and, to the extent permitted <br />by law, redacted all Social Security numbers; <br />2. I have redacted, to the extent permitted by law, each Social Security number in the attached <br />document. <br />I the undersigned, affirm under penalties of perjury, that the foregoing declarations are true. <br />~~~ <br />Signature of eclarant <br />~.:5!~nP:~, <br />Debra A. Guy <br />Printed Name of Declarant <br />~. ~~ ~;1'w~ ti' ~a (~~j~tC~' <br />~~ ~'L-i~.~~-- <br />_~ <br />,J~tJ _ 1 2006 <br />~OADE <br />,t Sp. F,E4tD, IN. <br />Cll'~ CLEn~ , <br />