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I-"#@<0@@,AnFmBeAHɠ3@(P6OA2x *x< !R @ 0Ej1 $౹6 ?ys`3πSIvAV1 7e܄ҿ`X f h0gG&JG `f s@6'H@ 碄߃ a8_gS 8 G^\٠', Тc@4Ѐ(7Vp|  9؁|;v x;(f<V\e`>Tׁ02T XW`!`0p@4JXQ D< AŨ6p3aOY|"<Of>òCҽ娲Ԕ#ʇ.K)/ʞLG7Z)Q|Ci|MG~>({ iʓ{(-ߎ ``i`*U` *$00}A3"6njIS|m3εoTOERx8E<``nP7A8PƂ20JA ppF1=@w tY t@K"rUi$gq1*˿Q~|E9DsgOKͬ)̠1OSUruJb,W' |8y|h\n+c>YdTJe%hhs\*G3KH]MIeW}FSFkFDt>@zkX֚&O )SzlJ^"yMrAFoMFbi<`+aaaAt* G m5~~~^t+uzѠWݠty:qXnέxnua玫W#6`SyW~4!F1Xw4g1RΗSԢi5Go6w*qQ 9yky~qZ^(5'*H^h_ԜWL//jnRX۔9Z݇;°8༼}泦ٽD𚅴ׯ貹t0دo.%չ2<[*̖ ;2^ݒL>92+%6/g.=/씨hMDVcP~mZaɭ}cewILМ?mxYDEjWtBdL]R3zHntz&͔Y畞X&kubMZ}\!DduYguYguYguYguYguYguYguYguYgwxǻԿau>|v2GoJmmiKH.7˵rmgXk^kkkkkkkkk/7]E pm'+ ÎrZOd\K8% endstream endobj 267 0 obj <> endobj 268 0 obj <>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (SI-YAAAAA+Calibri-BoldItalic) /Supplement 0 >> def /CMapName /Adobe-SI-YAAAAA+Calibri-BoldItalic-0 def /CMapType 2 def 2 begincodespacerange <00> endcodespacerange 2 beginbfchar <00> <20> <0020> endbfchar endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 269 0 obj <> endobj 270 0 obj <> endobj 271 0 obj <> endobj 272 0 obj <> endobj 1 0 obj <>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 1/Tabs/S/Type/Page>> endobj 2 0 obj [19 0 R 16 0 R 17 0 R 8 0 R 22 0 R 9 0 R 13 0 R 18 0 R 20 0 R 25 0 R 31 0 R 23 0 R 27 0 R 32 0 R 34 0 R 36 0 R 40 0 R 39 0 R 48 0 R 41 0 R] endobj 3 0 obj <>stream /P <>BDC BT /Artifact BMC /T1_0 1 Tf 3 Tr 12 0 0 12 68.3759 750.48 Tm ( )Tj EMC /P <>BDC -0.968 -5.542 Td ( )Tj EMC /P <>BDC 19.082 0 Td ( )Tj EMC /Artifact BMC 18.023 0 Td ( )Tj EMC /P <>BDC -24.106 -10.43 Td ( )Tj EMC /P <>BDC 7.164 0 Td ( )Tj EMC /Artifact BMC -15.881 -1.19 Td ( )Tj EMC /P <>BDC 14.327 -1.232 Td ( )Tj EMC /P <>BDC 6.439 -1.15 Td ( )Tj EMC /P <>BDC -20.769 -1.15 Td ( )Tj EMC /P <>BDC 3.277 -2.41 Td ( )Tj EMC /P <>BDC 13.158 0 Td ( )Tj EMC /P <>BDC 6.118 -1.22 Td ( )Tj EMC /P <>BDC 9.163 0 Td ( )Tj EMC /P <>BDC -30.615 -1.2 Td ( )Tj EMC /P <>BDC -5.88 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4148.2002 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4459 7622.3999 4.801 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4463.7998 7622.3999 1346.59998 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 7616.3999 4.801 10.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 7622.3999 4.801 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 7294.7998 4.801 321.59799 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 7294.7998 4.801 321.59799 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 7284 4.801 10.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 7290 4148.2002 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4459 7290 4.801 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4463.7998 7290 1346.59998 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 7284 4.801 10.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 6962.2002 4.801 321.84 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 6962.2002 4.801 321.84 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 6951.3999 4.801 10.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 6957.3999 2209.69995 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 2520.5 6951.3999 4.801 6 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 2520.5 6957.3999 4.801 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 2525.30005 6957.3999 1931.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4456.6001 6951.3999 4.797 6 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4456.6001 6957.3999 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4461.3999 6957.3999 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4466.2002 6957.3999 1344.19995 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 6951.3999 4.801 10.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 6628.6001 4.801 322.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 2520.5 6628.6001 4.801 322.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4456.6001 6628.6001 4.797 322.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 6628.6001 4.801 322.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 6617.7998 4.801 10.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 6623.7998 2209.69995 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 2520.5 6623.7998 4.801 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 2525.30005 6623.7998 1931.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4456.6001 6617.7998 4.797 10.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4461.3999 6623.7998 1349 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 6617.7998 4.801 10.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 6296.2002 4.801 321.60199 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 6291.3999 4.801 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 6291.3999 4.801 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 6291.3999 4145.7998 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4456.6001 6296.2002 4.797 321.60199 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4456.6001 6291.3999 4.797 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 4461.3999 6291.3999 1349 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 6296.2002 4.801 321.60199 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 6291.3999 4.801 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5810.3999 6291.3999 4.801 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 4397.5 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 4402.2998 4.801 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 4402.2998 1397.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 4397.5 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 4402.2998 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1712.90002 4402.2998 1428.19995 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 4397.5 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 4402.2998 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3145.8999 4402.2998 2669.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 4397.5 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 4402.2998 4.801 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 3771.1001 4.801 626.39801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 3771.1001 4.797 626.39801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 3771.1001 4.797 626.39801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 3771.1001 4.801 626.39801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 3761.5 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 3766.30005 1397.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 3761.5 4.797 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1712.90002 3766.30005 1428.19995 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 3766.30005 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3145.8999 3766.30005 2669.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 3761.5 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 3342.5 4.801 419.039 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 3342.5 4.797 419.039 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 3342.5 4.801 419.039 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 3332.8999 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 3337.69995 1397.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 3332.8999 4.797 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1712.90002 3337.69995 1428.19995 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 3332.8999 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 3337.69995 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3145.8999 3337.69995 2669.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 3332.8999 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 2912.8999 4.801 420 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 2912.8999 4.797 420 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 2912.8999 4.797 420 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 2912.8999 4.801 420 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 2903.30005 4.801 9.598 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 2908.1001 1397.30005 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 2908.1001 4.797 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1712.90002 2908.1001 1428.19995 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 2903.30005 4.797 9.598 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3145.8999 2908.1001 2669.30005 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 2903.30005 4.801 9.598 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 2483.30005 4.801 420 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 2483.30005 4.797 420 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 2483.30005 4.801 420 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 2473.69995 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 2478.5 1397.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 2473.69995 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 2478.5 4.797 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1712.90002 2478.5 1428.19995 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 2473.69995 4.797 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3145.8999 2478.5 2669.30005 4.801 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 2473.69995 4.801 9.602 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 2054.8999 4.801 418.80099 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 2050.1001 4.801 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 306 2050.1001 4.801 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 310.80099 2050.1001 1397.30005 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 2054.8999 4.797 418.80099 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1708.09998 2050.1001 4.797 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 1712.90002 2050.1001 1428.19995 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 2054.8999 4.797 418.80099 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3141.1001 2050.1001 4.797 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 3145.8999 2050.1001 2669.30005 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 2054.8999 4.801 418.80099 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 2050.1001 4.801 4.797 re f* Q EMC /Artifact BMC q 0.1 0 0 0.1 0 0 cm 5815.2002 2050.1001 4.801 4.797 re f* Q EMC EMC BT /P <>BDC 0 Tr 12 0 0 12 36.24 750.48 Tm [(Nam)-8 (e )]TJ EMC /P <>BDC 0 -2.77 TD [(S)-2 (tre)-2 (e)-3 (t )6 (A)-2 (d)-3 (d)-3 (r)13 (e)-2.9 (ss )]TJ EMC /P <>BDC 0 -2.772 TD [(Ci)4 (ty )]TJ EMC /P <>BDC 18.454 0 Td [(S)-2 (ta)-5 (te )]TJ EMC /P <>BDC 16.134 0 Td [(ZIP)-3 ( Co)-3 (d)6 (e )]TJ EMC /P <>BDC -34.588 -2.78 Td [(P)-2 (h)-3 (a)-3 (rm)6 (a)-3 (cy)10 ( Na)-3 (tio)-2.9 (n)-3 (a)-3 (l )10 (P)-2 (rov)9 (ide)-5 (r N)3 (u)-3 (m)-6 (b)-3 (e)-3 (r \()4 (NPI)-2 (\) )]TJ EMC ET /TD BMC BT /P <>BDC 12 0 0 12 451.296 650.616 Tm (Telephone )Tj EMC /P <>BDC -0.006 Tw 4.998 0 Td (Number )Tj EMC ET EMC BT /LBody <>BDC /T1_1 1 Tf 0 Tw 12 0 0 12 35.28 588.096 Tm [(P)-2 (a)-3 (rt 3)6 (:)-6 ( Re)-3 (c)6 (e)-3 (ipt Info)3 (r)9 (ma)-4 (tion )]TJ EMC /P <>BDC /T1_0 1 Tf 0.004 Tc 1.5 -1.24 Td (1. )Tj EMC ET /LBody BMC BT /P <>BDC 0 Tc 12 0 0 12 71.304 573.216 Tm [(In)-5 (clud)4 (e)-3 ( o)-5 (ri)5 (g)6 (ina)-5 (l p)-3 (h)6 (a)-3 (rm)6 (a)-3 (cy)10 ( re)-2 (ce)-3 (ipt)-2.9 (\(s\))6 ( o)-5 (r p)-2 (h)-3 (a)-3 (r)13 (m)-6 (a)-3 (cy)10 ( p)-5 (ri)5 (n)-3 (to)-4.9 (u)5.9 (t\(s\))4 (; )-2.9 (Cash)3.9 ( Re)-2.9 (g)6 (iste)-3 (r R)3 (e)-3 (ce)-3 (ipt)-3 (\(s\))6 ( w)10 (i)-7 (th)-5 (o)-3 (u)6 (t )]TJ EMC /P <>BDC 0 -1.2 TD [(p)-3 (h)-3 (a)-3 (r)13.1 (m)-6 (a)-3 (cy)10 ( d)-5 (e)-3 (ta)-5 (il)4 ( w)10 (il)4 (l n)-3 (o)-3 (t )-3 (b)-3 (e )5.1 (a)-3 (cce)6 (p)-3 (te)4 (d)-3 (. )6 (T)-8 (a)6 (p)-3 (e )5 (o)-2.9 (ri)5 (g)5.9 (ina)-4.9 (l p)-3 (h)-3 (a)-3 (rm)6 (a)-3 (cy)10 ( re)-2 (ce)-3 (ipt)6 (\(s\))6 ( t)-2.9 (o)-3 ( b)-5 (o)-3 (t)8 (to)4 (m)-6 ( o)4 (f )-3 (th)-5 (is )10 (p)-3 (a)6 (g)6.1 (e)-3 (. )]TJ EMC /P <>BDC /T1_2 1 Tf 0 -1.19 TD [(P)-2 (lea)-5 (se)]TJ EMC /Artifact BMC /T1_3 1 Tf 12 0 0 12 36.24 750.48 Tm 5.986 -17.162 Td ( )Tj EMC /P <>BDC /T1_0 1 Tf 0.286 0 Td [(DO)10 ( NO)8 (T)-8 ( st)-3 (a)6 (p)-3 (le)8 (. )]TJ EMC ET EMC BT /P <>BDC 0.004 Tc 12 0 0 12 53.28 529.752 Tm (2. )Tj EMC ET /LBody BMC BT /P <>BDC 0 Tc 12 0 0 12 71.304 529.752 Tm [(Rece)-5 (ipt)-3 (\(s\))6 ( mu)-2 (st )-3 (co)6 (n)-3 (ta)-5 (i)12.1 (n)-3 ( t)-3 (h)6 (e)-3 ( in)6 (fo)-5 (rm)-3 (a)6 (tio)-3 (n )5 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