Draw 5 FALCON NEST II , LLC
May 20,2014
Diana L. Cordray
Carmel Clerk Treasurer
(317)571-2414
Via E-mail: DCordrayPcarmel in.gov; csheeks@a carmel.in.cov; lohn.afexanderarenions.com:
ake.taylorastarfinancial.com
Re: Legacy TIF—Draw#5
Dear Diana:
•
Attached please find the Legacy TIF draw for the current month. If everything is in order,
please sign the Request for Disbursement Form and forward this draw to the Trustee.
Also attached is a budget sheet that will track all costs to date. Please let me know if
you have any questions.
Sincerely,
..
Rajai Zumot
Member of SALT, LLC
1356 BEVERLY RD SUITE 250 • MCLEAN, VA •22101
PHONE: (703) 893-7233 • FAX: (703) 893-5267
STATEMENT NO. 2
REQUESTING DISBURSEMENT OF FUNDS FROM PROJECT FUND PURSUANT TO
SECTION 4.3 OF THE TRUST INDENTURE BETWEEN THE CITY OF CARMEL,
INDIANA AND REGIONS BANK, AS TRUSTEE
Pursuant to Section 4.3 of the Trust Indenture (the "Indenture") dated as of December 1,
2013, between the City of Carmel, Indiana (the "Issuer") and Regions Bank (the "Trustee"), the
undersigned, as the Authorized Representative (as defined in the Indenture) of the Company,
hereby requests and authorizes the Trustee, as depository of the Project Fund created by and as
defined in the Indenture to pay to the Company or to the person(s) listed on the Disbursement
Schedule attached hereto out of the moneys on deposit in the Project Fund, the aggregate sum of
$ 23,464.91 to pay such person(s) or to reimburse the Company in full, as indicated in the
Disbursement Schedule, for advances, payments and expenditures made by it in connection with
the items listed in the Disbursement Schedule.
In connection with the foregoing request and authorization, the undersigned hereby
certifies that:
(a) the costs of an aggregate amount set forth in this written request
have been made or incurred and were necessary for the construction of the Project and
were made or incurred in accordance with the construction contracts, plans and
specifications, or purchase contracts therefor then in effect or that the amounts set forth in
such written request are for allowable Costs of Construction of the Project;
(h) the amount paid or to be paid, as set forth in this written request, is
reasonable and represents a part of the amount payable for the Costs of Construction of
the Project all in accordance with the cost budget; and that such payment was not paid in
advance of the time, if any, fixed for payment and was made in accordance with the terms
of any contracts applicable thereto and in accordance with usual and customary practice
under existing conditions;
(c) no part of said costs was included in any written request previously
filed with the Trustee under the provisions hereof; and
(d) such costs are appropriate for the expenditure of proceeds of the
Bonds under the Act.
This statement and all exhibits hereto, including the Disbursement
Schedule, shall be conclusive evidence of the facts and statements set forth herein and
shall constitute full warrant, protection and authority to the Trustee for its actions taken
pursuant hereto; and
This statement constitutes the approval of the Company of each
disbursement hereby requested and authorized.
IN WITNESS WHEREOF, the authorized representative of the Company has set his
hand as of the c day of . 2 ,20
FALCON NEST II LLC,
an Indiana limited liability company
By; SALT, LLC,Member .�..
By.
Rajai Zumot, Member of SALT, LLC
2
Pursuant to Section 4.3 of the
Indenture the foregoing
disbursement request is hereby
approved:
CITY„If Of ARMEL, . D ANA
Diana L. Cordray,IAMC,Clerk-Tr arer
3
LI Legacy TIF Draw
Application No.: 5
-1 Application Date: 14-M ay-14
Prepared By: . Kathy Tekulve
Telephone No (317)863-2052
Amount . $ 23,464.91
Reference or Total Retainage
Invoice Work This Invoice
Code Contractor/Payee Number Completed Period Amount
3 i GrossRoad Engineers, PC 14259 $ 15,510.00 $ - $ 15,510.00
.,.
$ 15,510,00 $ - $ 15,510.00
4 Weihe Construction, Inc. 3636 $ 7,019.80 $ (701,9 $ 6,317 82
$ 7,019.80 $ (701,98)i $ 6,317.82
I 1
Management Fees
.
. 1044A $ 1,689.74 $ (52.65)i $ 1,637.09
• $ 1,689.74 $ (52.65)1 $ 1,637.09
I 1
I Total ; 1 $ 24.219.54 ' $ (754-63)I 1 $ 23,464.91
I I ,
1 .
„I
oil
PLATINUM PROPERTIES MANAGEMENT COMPANY, LLC
INVOICE 1044A
May19, 2014
Zumot Real Estate Management, Inc. rzumot @zumot.net
Falcon Nest II, LLC
1356 Beverly Road
Suite 300
McLean, VA 22101
Re: Development Service Fees-The Legacy TIF Draw
Summary of May 2014 Construction Costs:
CrossRoad Engineers, PC $ 15,510.00
Weihe Construction, Inc. $ 6,317.82
Total Monthly Costs $ 21,827.82
Development Fee @ 7.5% $ 1,637.09
Please remit payment to:
Platinum Properties Management Company, LLC
9757 Westpoint Drive,Ste 600
Indianapolis, IN 46256
9757 Westpoint Drive,Suite 600, Indianapolis, IN 46256 (317) 818-2900
CrossRoad Engineers,PC
3417 Sherman Drive
Beech Grove, IN 46107
317-780-1555
Platinum Properties Management Co., LLC Invoice number 14259
Timothy Walter,P.E. Date 04/30/2014
9757 Westpoint Drive,Suite 600
Indianapolis, IN 46256 Project RIVER ROAD RECONSTRUCTION-TALL
TIMBER RUN TO 146TH ST.
For services performed March 29,2014 through April 25,2014,
PROMPT PAYMENT OF INVOICE IS APPRECIATED!!
The services were provided in accordance with our proposal dated February 14,2014,and our Professional
Services Agreement dated March 20,2014.
Amount
1.Topographic Survey
Contract Amount 16,500.00
Percent Complete 80.00
Total Billed 13,200.00
Current Billed 13,200.00
2.Preliminary Design
Contract Amount 8,100.00
Percent Complete 10.00
Total Billed 810.00
Current Billed 810.00
4.Phase I Final Design
Contract Amount 37,500.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
5. Phase I Drainage Permitting
Contract Amount 2,000.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
7. Phase I Rule 5 Permit Application
Contract Amount 1,000.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
Platinum Properties Management Co.,LLC Invoice number 14259 Invoice date 04/30/2014
Page 1 of 3
Platinum Properties Management Co.,LLC Invoice number 14259
Project RIVER ROAD RECONSTRUCTION-TALL TIMBER RUN TO 146TH ST. Date 04/30/2014
Amount
8.Roadway Legal Descriptions
Contract Amount 3.00 5,400.00
Percent Complete 0.00
Total Billed 0.00 0.00
Current Billed 0.00 0.00
9.Phase I Monumentation
Contract Amount 1,500.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
10.Preliminary Design for RAB @ Cherry Creek Blvd.
Contract Amount 9500.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
13.Maintenance of Traffic to close traffic during Construction
Contract Amount 3,000.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
14. Meetings
Contract Amount 3.00 1,200.00
Percent Complete 0.00
Total Billed 0.00 0.00
Current Billed 0.00 0.00
16.Wetland Permitting
Contract Amount 2,000.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
16a.Williams Creek-Natural Resource Assessment
Contract Amount 3,100.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
16b.Williams Creek-Storrnwater Consultation
Contract Amount 5,700.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
17.Construction Cost Estimate-Preliminary Design Area
Contract Amount 1,500.00
Percent Complete 100.00
Total Billed 1,500.00
Current Billed 1,500.00
Platinum Properties Management Co.,LLC invoice number 14259 Invoice date 0413012014
Page 2 of 3
Platinum Properties Management Co.,LLC Invoice number 14259
Project RIVER ROAD RECONSTRUCTION-TALL TIMBER RUN TO 146TH ST. Date 04!3012014
Amount
18.Construction Cost Estimate-Final CD Area
Contract Amount 3,000.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
19.Project Manual
Contract Amount 2,500.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
21.Topographical Information-Final CD Area
Contract Amount 800.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
23. 12"Water Main Relocation Design-new Eliz.Warner culvert to Community Dr.
Contract Amount 4,900.00
Percent Complete 0.00
Total Billed 0.00
Current Billed 0.00
Total 15,510.00
Invoice total; 15.510.00 ,/
Z.11
�a 1 �
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{1� .1
Pfetinunk Properties tvlanagement Co.,LLC Invoice number 14259 Invoice date 04/30/2014
Page 3 of 3
APPLICATION FOR PAYMENT
PRO-:ECT NAME: Legacy Towns&Rats Ph II-OHshe
OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER:Ptalinvm Proper-lien,LLC CONTRACTOR WOW.carrtruction.k:c. INVOICE NO-, 3638
CONTACT: natal ZUrret CONTACT:TLm Waller CONTACT.Man 5.731!
.OLIRLSS. 1356 aever7 Raad.Sale 300 ADDRESS:9757 Weetpoint Drive,SuIe 600 ADDRESS.152155ton Creek Wa APPLICATIONDATE: 0%2014
I:1cLean,Virginia 22101 Y Y APPROVED E- 10%
Indianapolis,IN 46256 Ncotesvillc,IN 46060 APPROVED EY,
--- Pnone: _ Phor'.a: 317 710-2900 590-801701.11 Phony 311)776-2566(e1,776.3050 11) DATE:
A 6 _ Cr Cr D 0 F G H=EE•F-G P-11,10 I k LGJah M=D-H+L N
Reject Cost Work Deseop5eo ...- Unit 5ct:edeled Work
Cede Code Completed Materials Talalfon,paHted % Previous Retalnoga Te{at � pqL,7p Ne!Pay i
PnW Value P,0,1,1 s This - Stored MC Stcred TO Date Comp'_ Reteinage ?his Period Retained PAY 17E 61000r
Legacy Towns&Flats Phil-Offalte
Earthwork
Lgy I 4a (Jemoldion(146th St R/INi NA $19,715.64 53,200.00 $3,200.00 16% 5320.00 5320.00 516,835.64 67.880.00
Lgy I 4d Prelirn Erosion Control NA 55.23824 $5,238.24 $5,238.24 100% $523.82 $523-82 $523.82
Lgy I 4e Mass FueCavation-Street NA $8,572.38 56030 38
56,000.36 70°.t. 5600.04 $600.04 53,172.04
Lgy I 4g Slte&Finish Grading-Street NA $8,058.16 55,641.16 55,641.16 70% $564.12 $564.12 $2,981 11
Lgy I 4l1 Soil slatrlizafio:l NA $12,750.00 $8,925.00 58,925.00 70% $892.50 $892.50 $4,717.50
Site Utilities
Lgyl Sb Sanitary Sewer Mains NA 516,574.00 516,574.00 $16,574.00 1DOY. $1,657.40 $1,657.40 51,657.40
Lgy I 6a Storm Sewers NA 537,494.00 526.494.00 54,000.00 530,494.00 71% 52,6.49.40 $400.00 53,049.40 510,049.40 53,600.00
Lgy 1 65 Subsurface Drains NA 515.450.00 $10,815.00 $10,815.00 70% 51,081.50 51,081.50 55,716,50
Lgy I 76 Water Maws NA $84,707.00 $64,707.00 $64,707.00 t00% $6,470.70 56.470.70 $6,470.70
Lgy I I 5b Maint Bands(San,Storm&Water) NA $850-00 $650.80
Legacy Master Stormwater Park
I
Earthwork
I Lyy 5P 4c Topsoil Stripping NA 53,114.00 $3,114.00 53,114.00 100% 5311.40 $311.40 $311.40
Lgy SP 4e Mass Fkravation-Storrs 8MP NA $24,451.78 $24,451.78 $24,451.78 100% 52,445,18 $2,445.18 $2,445.18 /
Lily SP 4o Site&Finish Grading-Storm 13MP NA $7.010.80 $7,019.80 57,019.80 ton% $701.98 $701.98 5701.98 58.317,82
CO-#1-Site Concrete
I.gy I Se 6"Chairback Curb 510.59/11 513,860.00 513,860.00 513,869,00 100% 51,388.00 51,386.00 51,386.00
LgyI 8b Whuoi Chair Ramps(8'path) 3600/ea $1,200.00 $1,200.00
Lgy 1 85 Wheel Chair Ramps(CA Walk) $325/ea $978.00
Lgy I 85 Common Area Sidewalk $3.10isf $7.201.30 $975.00
57,201.30
1 g I 8c 8'Chairbaok Curb 513.809f $5,865.00 $5,065.00
l_gy I 8; Transition Curb and Slab NA $1,6650.00 51,650,0-0
Lgy 1 8c Heavy Duty Cross Walks 815/51 $2,775.00 32,775.00
Ley I 15b Carmel Maintenance Bond NA $300,00
5300.00
LgyI 80 Cp412 -Thermalbalnkets $1.00/1 51,320.00 51.320,00 51,320.00 5132.00 5132.00 $132.00
Lgy SP 4a CO113-Undercut&install brier in BAIT' NA $17,322.50 517,32250 517,322.50 51,732.25 $1.732.25 $1,732.25
t
f
TOTAL r 5276,483.80 5204,463.06 $14,219.80 $218,682.85 i 76 520,445.31 $1,421.98, $21,868.29 579,649,23 512,797.821
5169.203,06
IA !] ._ TEA Uocument G702
Application and Certificate for Payment •
TO OWNERPiatinum Properties PROJECT: Legacy Town&I tats Ph it APPLICATION d■Q•1b3b
9757 Westpoint Drive
Distribution to:
Suite 600 PERIOD t0s OWNER XU
Indianapolis„IN 46256 CONTRACT FOR: ARCHITECT [I
FROM CONTRACTOR: Weihe Construction,In VIA ARCHITECT: _
15215 Stony Creek Way CONTRACT DA E:E: CONTRACTOR 1.
Noblesville,IN 46060 PROJECT NOS:2t113a3 O1
FIELD 0
OTHER ❑
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of'the Contractor's knowledge, information
Application is made for payment,as shown below,in connection with the Contract and belief the Work covered by this Application for Payment has been completed in accordance
with the Contract Documents,that all amounts have been paid by the Contractor for Work for
AIA Document G7037',Continuation Sheet,is attached.
1,ORIGINAL CONTRACT SUM 223,995-00 which previous Certificates for Payment were issued and payments received Duni the Owner,and
. $ that current pa t shown -rein is n w due,
2.NET CHANGE BY CHANGE ORDERS. $ 17,322.50 CONT-. 0•• `ye ie C o t c, +n,
3,CONTRACT SUM TO DATE(Line;~:;'2) $ 241,317.50 ! * r �1
2{)3,502.$6 $y t•t '�� Date: '4-( C�t `1-
4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ State of: '
5.RETAINAGE: County of•Hamilton
x.10.00 %of Completed Work
(Columns D+E or.G703) $ 20,350.29 Sltbsribed and swornT+� e qre
me this -613 day da of
b. %of Stored Material C' d ,
(Cotanin F on G703) $ Notary Public: .
Total Retainage 20,350.29 My commission expires:
(Lines Sa+5b,or Total in Column I ofG703).,.... S )t) 2-0 l�
6.TOTAL EARNED LESS RETAINAGE 5 183,152.57 ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 minus Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT S 170,354-75 this application,the Architect certifies to the Owner that to the best of the Architect's knowledg
(Line 6from prior Certificate) information and belief the Work has progressed as indicated, the quality of the Work is in
- accordance with the Contract Documents, and the.Contractor is entitled to payment of the
B.CURRENT PAYMENT DUE 1 5 12;797.52 1 AMOUNT CERZTFIED, r
9.EALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED ..,,_.. $ f ZI 797`1: Z.
(Line 3 minus Line 6) - $ 58,164.93 .
-
(Attach explanation if aniDunf certified d yers filmy the amount applied.Initial all figaras on this
. Application and on the Continuation Shei that are changed to conform with the amount certified)
•CHANGE ORDER Sta./MARY ADDITIONS DEDUCTIONS ''ARCHITECT:
Total changes approved in previous,months by Owner $ $ u r
•
By. _n Date: j�t J�
Total appiovtd this month $ S rr
This Certificate is notvegotiable.The AMOUNT CER1TIED is payable only to e Contractor
TOTAL $ $ named herein.issuance,payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order $ the Owner o.Contractor under this Contract.
CAUTION:You should sign an original AlA Contract Docarnent,on which this text appears in R D.An original assures that changes will not be obscured,
NA Document G702^'—1992,Copyright®1953,1983,1955,1971,1978,1983 and 1992 by The American Instl4Jte of Architects All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law
and International Tteasies.Unauthorized reproduction or distribution of this ALAS Document,or any po n oqf it,may result in severe civil and criminal penalties,and Possible under the lauw,r-a,,haler.,are permitted to reproduce ten(10)copies of this document when complet'N report copyright violations of AlA Contract Documents,e-mawill he American Institute Of A�rchittects galrt
counsel_capyrigMeeia_org, d
t n c--
c/), 43k, ,At k, ._)&-i . x.\
CONTINUATION SHEET
—• - AlA DOCUMENT G703 (Instructions on reverse side) PACE OF PAGES
AM Document 0702, APPLICATION AND CERTIFICATE FOR PAYMENT,
containing Contractor's signed Certification, ii,attached APPLICATION NO-:
in tabulations below, amounts are stated co the nearest do[lar.
AFPLICATION ERIOD TO: 3636
Use Column I on Contracts where variable :etainage for line items may a PERIOD TO: 4/3012014
apply. ARCHITECT'S PROJECT NO.:
A B i G D E F 2f11343-01
G H 1
1 WORK COMPLETED
MATERIALS TOTAL
ITEM
NO. DESCRIPTION OF WORK SCHEDULED 1 ;1 Old PREVIOUS PRESENTLY COMPLETED HALANCE RETAINAGE
VALUE APPLICATION THIS PERIOD (NOT AND DATE % C) 3I (IF VARIABLE)
(0 + E) (ncr rrI TO DATE (G c FINISH
RATE)
0 OR E) (D+E+F) (C-G)
JlO Demolition-00-00 19,715.64 3,200.00 3,200.00 16.23 16,515.64 320.00
-00 Prelim Erosion Control 5,238.24 5,238.24 5,238.24 100.00 523.62
3 glass Excavation-Street 8,572.38 I 6,000.38 6,000.38 70.00 2,572 00 600.04
-00 rte 8 Finish Grading-Street 8,058.16 5,641.16 5,641,16 70-01 2,417.00 564.12
5 .oil Stabilization 12,750.00 8,925.00 I 8,925.00 70.00 3,825.00 892.50
6-00 •aniiary Sewer Mains 16,574.00 16,574.00 16,574.00 100.00 1,657.40
7-00 storm Sewers 37,494.00 26,494.00 4,000.00 20,494.00 81.33 7,000.00 3,049.40
8 00 subsurface Drains 15,450.00 10,815,00 10,815.00 70.00 4,535.00 1,081.50
09-00 aterrnains 64,707.00 64,707.00 64,707.00 100.00 6 L70.70
10-00 aintenance Bonds 850.00 850.00
1 00 opsail Stripping 3,11400 3,114.00 3,114.00 100.00 311.40
2-00 ass Excavation-Storm BMP 24,451.78 24,451.78 24,x51.7$ 100.00 2,445.18
3-00 Site&Finish Grade-Storm BMF 7,019.80 7,019.80 7,019-80 100.00 701.98
(O 01 Undercut swalelpond 18,590.00 18.590.00 18,590.00 100.00 1,859-00
00-02 Credit on CO-01 -1.267.50 -1,267.50 -1,267.50 100.00 126.75
C0-03 Freeze protection blankets 1,320.00 1,320.00 1,320.00 100.00 •
(10-04 Credit on CO-03 -1.320.00 -1,320.00 -1,320.00 100.00
I
t , AAi�011518UMENT G702 •CONTINUATION SHEET FOR 0702 • 7992 EDITION•A1A6 • elI992•THE AMERICAN INSTITUTE OF ARCHITECTS 1735 5 NEW YORK
84.33 37,814.64 20,350.29
-� '1�, AVENUE,NV„WASHINGTON,D.C.20O06-5292•WARNING Unlicensed photocopying violates US_copyright aws and we subject the violator to legal prosecution,
:.� �� G703-1992
CAUTION.You should use an original AIA,document which has this caution printed in red.An original assures that changes will not be obscured as may eccair when documents are reproduced.
APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN
SubContraQOror Supplier Name Weihe Construction,Inc.
Subcontractor or Supplier Address Noblesville,IN 48080 Phone (317)776-2966
Type of Service Furnished Construction Construction Cost Division Number
Project(Building Number) Legacy Town B.Flats Ph II
Owner ?latinurn Pro prbe5
Appiicalio:i NUM ber 3636 Date 413C/21114
Period From 4!1!2014 fu ,/30'20]1
Original Contract Sum..................... ...... $ 223,;95.00
Net Change by Approved Change Orders $ 17,322.50
Contract Sum to Date
Total In-Place Work Completed s 2[13,502.6.5
Value of Material Stored on Site -
•
Total Earned to Date S 203,:1112.95 �^ ^
Retained Percentage .,,..,,, 20,3517.29_
Total Earned Less Retaiitage 5 .1.83,1 t2.57
Less Previous Certificates for Payment . .......... ..• P 170,354J-5
Current Payment Due g _1.2297.0
The undersigned hereby certifies that the amount Earned and Due the Undersigned for all materiels,supplies
furnished,and labor and services of every nature performed by the Undersigned for the use on or in
connection with the above named Project.
1) Has been paid in full as per shown(except Amount Due as listed below)through the
above-mentioned pay period;and
2) The Undersigned hereby warrants that the premises of the above-named job cannot
be made subject to any valid lien or claim by anyone who furnished materials,supplies,
tabor or services to the Undersigned for use In the above-named Project;and
3) The Undersigned hereby waives any and all claims of whatsoever kind or nature against
the General Contract,and the Owner,and against the building(s),improvements or
Project,and the land on which same Is located for any labor,materials,or supplies
furnished or services performed through the above-mentioned pay period.
This release is given in order to induce payment in the Amount Due of$ $ 12,797,82 and on
receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes vaild,enforceable
and of full effect. Upon attachment of the legal description of the Project,the release my be recorded by
the Owner or Mortgagee of the Project.
Notwithstanding the foregoing,the Undersigned does hereby unconditionally waive and release any and all
liens or rights to liens upon the premises,Improvements thereto,or monies due in connection therewith,
with respect to mordes due the Undersigned for previous payment requests in the total sum of
$ 12,797.82 _,the receipt and sufficiency of which Is hereby acknowledge.
Dated this 30 day of April 2014
Weihe Construction,Inc.
State of Indiana By:
(Su erratic,Sr&Te to h, e
1
) SS' Igred)
County of Hamilton ) Title Project Manager
Before me,a Notary Public in and for mid County and Slate,this 30 day of April 2014,
personally appeared Jay Steehler known to me to be URn-elect Manager of the Undersigned
who acknowledge the execution of the foregoing for and on behalf of the Undersigned.
wI1NESS my hand and Notarial Seal.
Dated this 30 day of April 2014
My commission expires: Oct.2015 l L1 ,
Netire Pneiic
My county of residence is: Hamilton Michelle Garde
(Printed)