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Prescribed by the <br />State Board of Accounts <br />(2005) <br />Declaration <br />County Form 170 <br />This form Is to be signed by the preparer of a document and recorded with each document fn 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. 1 have reviewed the attached document for the purpose of Identifying and, to the extent permitted <br />by law, redacting all Social Security numbers; <br />2. t have redacted, to the extent permitted by law, each Soclai Security number In the attached <br />document. <br />i, the undersigned, affirm under the penalties of perjury, that the foregoing declarations are true. <br />ignature of Declarant <br />Shawn E. Peterson <br />Printed Name of Declarant <br />