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I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public <br />works are true and correct. <br />Dated this 1 )� _. day of e 17 , 20 M <br />SAMANTHA DAWN BROWN <br />°TMy, <br />Notary Public, State of Indiana <br />*; * <br />ELKHART County <br />BEAL <br />Commisslon # NP0760326 <br />,- <br />My Commision Expires <br />DECEMBER 04, 2032 <br />Subscribed and sworn to before me this <br />My Commission <br />County of Residence <br />k," IL 7urt k 1/Y\�oU� 2,C, <br />Contractor/Bidder (Firm) <br />Signature of Contractor/Bidder or Its Agent <br />& - Q kl'j, � . P"'J'2- <br />Printed Name and Title <br />day <br />20 <br />Notary Public <br />lrtI4�r_r <br />12 <br />