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AFFIDAVIT

OF
CHANGE OF ADDRESS

The undersigned,

, an officer of
, a corporation duly organized and existing under the laws of the
State of
, _________________________, hereby declares that the address
of the company, to wit,
Old address
Was on the

day of

changed to:

New address
Given this

day of

(By)
(Title)

Sworn before me this

day of

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