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COUNTY FORM 170 <br />DECLARATION <br />This form is to be signed by the preparer of a document and recorded with each <br />document <br />in accordance with IC 36-2-7.5-5(a). <br />1, the undersigned preparer of the attached document, in accordance with IC 36-2-7.5, do <br />hereby affirm under the penalties of perjury: <br />y: <br />true. <br />1. I have reviewed the attached document for the purpose of identifying <br />and, to the extent permitted by law, redacting all Social Security numbers. <br />2. 1 have redacted, to the extent permitted by law, each Social Security <br />number in the attached document. <br />1, the undersigned, affirm under penalties of perjury, that the foregoing declarations are <br />Signature of Declarant <br />-'S� 44e"�nli <br />Printed Name of Declarant <br />