STATE OF LOUISIANA
PARISH OF CADDO
BEFORE ME, the undersigned authority, a Notary Public duly
commissioned, qualified and sworn in and for the State of
Louisiana and said Parish aforesaid, personally came and appeared
who after being by me first duly sworn, did depose and say:
THAT ___________________________________________ operating a
business under the Trade Name of ________________________________
located at ______________________________________________________
in the Parish of Caddo, State of Louisiana.
SWORN TO AND SUBSCRIBED before me, on this the ________ day
of _____________________, 20_______.