ࡱ>    n @ cbjbj $>&"8[\d*JNUt<a&))))))$+R*.7)e7)*a&a&b pQp#jU  *0*...7)7)t|dt|INITIAL FOSTER HOME/ADOPTION EVALUATIONAGENCY NAME: FORMTEXT      AGENCY LICENSE NUMBER: FORMTEXT      Date of Report: FORMTEXT      Use Tab key to advance to the next field. Use Enter key to add additional lines within a field. For Items #7 Social History, #8 Health, #10 Children answer all items for each individual person together and repeat as necessary for additional people. 1.FOSTER HOME INFORMATION:Foster home name: FORMTEXT      Foster home license number, (CF # or CG#): FORMTEXT      Address: FORMTEXT      Telephone number (s): FORMTEXT      Driver s license number; verification of valid driver s license: FORMTEXT      Members of the household (Name, Role, Date of Birth): FORMTEXT      2.SOCIAL WORK CONTACTS: (Date, Location, Persons Interviewed) FORMTEXT      3.DIRECTIONS TO HOME: FORMTEXT      4.COMMUNITY:Type of community (rural, urban, etc.): FORMTEXT      Socio-economic makeup: FORMTEXT      Racial/cultural makeup: FORMTEXT      Availability of recreational facilities: FORMTEXT      School system, including special education: FORMTEXT      Hospitals and medical care: FORMTEXT      Availability of churches, noting family s choice of church: FORMTEXT      5.HOME:Description of home and rooms, noting condition, layout, appearance: FORMTEXT      Explanation of proposed sleeping arrangements for family members and foster children: FORMTEXT      Description of play space: FORMTEXT      Any safety considerations, including weapons or pets: FORMTEXT      If there are pets, does the pet have current vaccinations?  FORMDROPDOWN Is the animal licensed if that is required by the municipality where the family lives? FORMDROPDOWN Are there smoke detectors on each floor and between each sleeping area and the rest of the home? FORMCHECKBOX  Yes  FORMCHECKBOX  NoIs there a carbon monoxide detector installed as recommended by the manufacture? FORMCHECKBOX  Yes  FORMCHECKBOX  NoAny water hazards on or near premises and an explanation as to how applicant would safeguard children from them: FORMTEXT      Water, sewer, refuse arrangements, health inspection results if applicable: FORMTEXT      Water temperature tested, less than 120o Fahrenheit? FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT      Emergency Procedures form completed: FORMTEXT      Adequacy of the house, property, neighborhood, schools and community for the purpose of fostering as determined by an on-site visit: FORMTEXT      Means of transportation; i.e. ages and makes of automobiles, accessibility of public transportation if needed: FORMTEXT      6.FINANCIAL:Sources of income, how this was verified, outline of expense and how expenses were verified, indebtedness, assessment of familys financial stability and ability to meet their needs using their current income. Is the family current on their bills? Can the family meet the financial expenses associated with having a foster child placed in the home prior to any payments starting? FORMTEXT      If child support payments are ordered, are the payments being made and are they current? If there are arrears, how much are they and what is the plan to bring the payments current? FORMTEXT      If income is based on disability, i.e. SSI, Social Security Disability, long term disability payments from a job, workmens compensation, etc., there must be verification of the physical or mental disability and an assessment of how that impacts the ability to provide foster care or be a member of the household.  FORMTEXT      Financial statement completed to reflect debt to income ratio and worker s assessment of financial stability? Yes FORMTEXT      7.SOCIAL HISTORY: (for each adult member of the household)Descriptive information: Age, height, weight, hair color, nationality, race or ethnicity, place of birth. Family of origin description. Includes:Number of siblings, parents roles, personalities, expectations, parenting involvement, styles, values.Relationship with each parent and siblings (if any) growing up and now. Parents/primary caretakers childrearing techniques, including discipline. How family dealt with losses.Parents substance use and how it affected the family, lasting impact on individual if present.How family dealt with any abuse or victimization issues, continuing impact on individual.Role of religion in the family.Other significant relationships, influences, e.g. grandparents, step parents, aunts, uncles.Any history of out of home care? This should include any history in non-court-ordered out of home care.Educational history and any special skills and interest:Employment history If the person does not have an employment history or there are large gaps in the employment history, explain how they were supported during that period of time:Relationship history Significant relationships prior to current one; how they ended; if previously married, whether divorce has been obtained or considered, any children from previous relationships. If there are previous relationships that produced children who are living with the applicant, what is the level of contact with that parent who is not living in the home? Note any history of involvement in domestic violence, including as a victim, or absence of history:Description of personality, personal goals, hobbies, interestStrengths and weaknesses worker s assessment in addition to what they tell you: FORMTEXT      8.HEALTH:Physical, mental and emotional health and substance use history.Indicate current health status:Describe current substance use patterns, history if indicated. If there is a past substance use problem including alcohol use, give particulars, indicate how diagnosed, resolved, and when:Does person smoke?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, do they smoke in the house?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoMental health treatment, if any. Include current prescriptions for psychotropic medications. Documentation from professional providing treatment/medication review:Reference a medical statement, completed within the 12 month period before conclusion of the evaluation, for each member of the household that indicated that the member has no known condition which would affect the care of a foster child or any other determination if different. For non-caregivers, this must include the amount of time it takes for the caregiver to meet the needs of the household member: FORMTEXT      9.FAMILY LIFE:Marital and family status and history, including current and past level of family functioning and relationships and any incidents of domestic violence:Current relationship. Include:Brief history, including date and place of marriage, if applicable.Verification of claimed marriages and divorces.Strengths of relationship, areas of work or attention.Common/shared interests or lack thereof. Roles, division of labor, decision-making process, handling stress or disagreements.Assess stability of the relationship.  FORMTEXT      Family:Activities, goals, values, role of religion, church involvement.  FORMTEXT      Arrangements for substitute childcare and ongoing supervision. FORMTEXT      Challenges, stressors, any history of help-seeking.  FORMTEXT      Losses, including infertility, and how dealt with.  FORMTEXT      Expected impact of fostering on all members of the household. FORMTEXT      Any individuals other than children of applicants living in the family, impact on family.  FORMTEXT      10.CHILDREN:All children must be interviewed/observed apart from the parents, even children no longer living in the home, or the agency must note all attempts to contact them. If unsuccessful, the applicant/other siblings explanations as to why you were unable to contact them. For each child living in the home:Identifiers: name, birth date, race (if different from parents) school and grade, and/or employmentParents description of childs personality, interests, activities.Workers assessment of childs adjustment, development, special needs, relationships with parents and others and strengths and weaknesses. Childs ideas and attitudes about fostering based on interview with the child.Childs description of the discipline techniques used in the family. For children who are grown or out of the home:Identifiers: name, age, where living, marital status. School and/or employment.General adjustment: note if any problems with the law.Their opinion of their parents parenting skills and of their desire to foster children. Description of the discipline techniques used when they were a child. The willingness of the adult child to provide substitute care, if appropriate, or be involved with the foster children who may be placed into the home. Any ongoing reliance by the adult child on the applicant for child care, monetary assistance, etc.  FORMTEXT      11.PARENTING:Parenting skills and attitudes toward childrenParenting values:Most important things for parents to do, what they will do similarly to their parents, what they hope to improve upon.  FORMTEXT      Knowledge of child development, appropriateness of expectations of own children, foster children, if different.  FORMTEXT      Ability to provide infant care:Equipment, safety measures in place (e.g. gates, monitor, car seat, play area, pets, substitute care givers) FORMTEXT      Safe Sleeping requirements are reviewed FORMTEXT      Safe play areas are available FORMTEXT      Understanding of infant care FORMTEXT      Substitute care arrangements  Day care arrangements if caregiver(s) work outside of the home, identify Emp&8Rln  $ & ( µꛔ›jYAj/jhWhWCJOJQJU^JaJ hWhWCJOJQJ^JaJ)jhWhWCJOJQJU^JaJ hWh:mj\hWhGjU hWhGjjhWhGjU hRh:mhc8h:m5jhc8hW5Ujhp@4UmHnHuj^hWhWUhWjhWUhRh:m5 hRhTA hRhA9PRl8bkd$$Ifl4F+y,$    4 lalf4 $Ifgd: #$IfgdW $$Ifa$gd:<kd$$Ifl4y,y,4 lalf4 $IfgdA98ccB 6 8 : ?kdD$$Ifl4r P+y, \  4 lalf4 $Ifgd:d$If^gdW $Ifgd: #$IfgdW $$Ifa$gd:( 2 4 6 8 : > 0 4 6 : r t »{ppe^PeBe; hWh:jhp@4UmHnHujhWhx/#U hWhs>jhWhs>UhRh:OJQJhRh:5 hRh:hWh <B*aJphhWh <B* aJphf hRh hRh:m5OJQJ hRh:m hWh:mCJOJQJ^JaJ)jhWhWCJOJQJU^JaJ.jhp@4CJOJQJU^JaJmHnHu: < > 4 6 8 o<kdX$$Ifl4xy,y,4 lalf4 $If^gd:<kd$$Ifl4Ey,y,4 lalf4 $IfgdA98 : @ r t v f]] $Ifgd:Okd$$Ifl40y,*4 lalf4 $$Ifa$gd:<kd$$Ifl4y,y,4 lalf4 PG $IfgdA9Lkdp$$Ifl0y,*4 lal #$IfgdW $Ifgd:Okd$$Ifl40y,*4 lalf4   $ & ( * > @ B L N P R j l n p ղիΒղիrk hRhWj hWhGjU hWhGjjhWhGjUjZhWh7kzUhRhTAOJQJ hWhTAjhp@4UmHnHujhWh7kzU hWh4jhWh4U hRhTA hRhp< hRh:hRh:OJQJ' $ & ( P i`W #$IfgdW $Ifgd:Okd<$$Ifl40y,*4 lalf4 $Ifgd:<kd$$Ifl4py,y,4 lalf4P R T V X j lcc $Ifgd:<kd$$Ifl4py,y,4 lalf4 $Ifgd:Lkd$$Ifl0y,*4 lalj l n PG $Ifgd:Lkd$$Ifl0y,*4 lal #$IfgdW $Ifgd:Okd$$Ifl40y,*4 lalf4 i`W #$IfgdW $Ifgd:Okd $$Ifl40y,*4 lalf4 $Ifgd:<kd2 $$Ifl4py,y,4 lalf4 lcc $Ifgd:<kd $$Ifl4py,y,4 lalf4 $Ifgd:Lkdx $$Ifl0y,*4 lal PG $Ifgd:Lkd, $$Ifl0y,*4 lal #$IfgdW $Ifgd:OkdD $$Ifl40y,*4 lalf4 "$&:<>HJLNR0246Jƿƿ}oƈ}j hWhWUhRhzOJQJ hRhzhRh5hRhz5jl hWhWU hRhWhRh:OJQJ hRh:hRhWOJQJjhp@4UmHnHuj hWhWU hWhWjhWhWU' "$Li`W #$IfgdW $Ifgd:Okd $$Ifl40y,*4 lalf4 $Ifgd:<kd $$Ifl4py,y,4 lalf4LNPRXl`` $$Ifa$gdz<kdN$$Ifl4y,y,4 lalf4 $Ifgd:Lkd $$Ifl0y,*4 lalPG $IfgdzLkd$$Ifl0y,*4 lal #$IfgdW $IfgdzOkd$$Ifl40y,*4 lalf4024\f]T #$IfgdW $IfgdzOkd`$$Ifl40y,*4 lalf4 $$Ifa$gdz<kd$$Ifl4y,y,4 lalf4JLNXZ\^b~468:NPR\^`b "ƿѐƥтƥtƥjdhWhWUjhWhWUjhWhWU hRhW hRhUWhRhUWOJQJhRhUW5 hRhzhRhWOJQJ hWhWjhp@4UmHnHujhWhWUjhWhWU-\^`bh~l`` $$Ifa$gdUW<kd$$Ifl4y,y,4 lalf4 $IfgdzLkdH$$Ifl0y,*4 lal~VMD #$IfgdW $IfgdUWOkd$$Ifl40y,*4 lalf4 $IfgdUWOkd$$Ifl40y,*4 lalf44lcc $IfgdUW<kd$$Ifl4py,y,4 lalf4 $IfgdUWLkdp$$Ifl0y,*4 lal468`bdPG $IfgdUWLkd$$$Ifl0y,*4 lal #$IfgdW $IfgdUWOkd<$$Ifl40y,*4 lalf4dfhi`W #$IfgdW $IfgdUWOkd$$Ifl40y,*4 lalf4 $IfgdUW<kd$$Ifl4py,y,4 lalf4lcc $IfgdUW<kdF$$Ifl4py,y,4 lalf4 $IfgdUWLkd$$Ifl0y,*4 lal "JLNPG $IfgdUWLkd$$Ifl0y,*4 lal #$IfgdW $IfgdUWOkd$$Ifl40y,*4 lalf4"$8:<FHJL024>@BDƿƿƿƿ{phRh@OJQJhRh@5j4hWhWUjhWhWUjhWhWU hRhWhRhUWOJQJ hRhUWhRhWOJQJjhp@4UmHnHujhWhWU hWhWjhWhWU,NPRi`W #$IfgdW $IfgdUWOkdX$$Ifl40y,*4 lalf4 $IfgdUW<kd$$Ifl4py,y,4 lalf4lcc $IfgdUW<kd$$Ifl4py,y,4 lalf4 $IfgdUWLkd@$$Ifl0y,*4 lalBDFPG $IfgdUWLkd$$Ifl0y,*4 lal #$IfgdW $IfgdUWOkd $$Ifl40y,*4 lalf4FHJi`W #$IfgdW $IfgdUWOkd$$Ifl40y,*4 lalf4 $IfgdUW<kdb$$Ifl4py,y,4 lalf4l`` $$Ifa$gdsXJ<kd$$Ifl4y,y,4 lalf4 $IfgdUWLkd$$Ifl0y,*4 lal VMD #$IfgdW $IfgdsXJOkd$$Ifl40y,*4 lalf4 $IfgdsXJOkdt$$Ifl40y,*4 lalf4tvxz  ~ܹծՠܹծՒܹծrܹjx$hWhWUhRhsXJOJQJ hRhsXJj"hWhWUj!hWhWUhRhWOJQJjhp@4UmHnHuj\hWhWU hWhWjhWhWU hRhWhRh@OJQJ hRh@,tlcc $IfgdsXJ<kd> $$Ifl4y,y,4 lalf4 $IfgdsXJLkd$$Ifl0y,*4 laltvxPG $IfgdsXJLkd!$$Ifl0y,*4 lal #$IfgdW $IfgdsXJOkd $$Ifl40y,*4 lalf4 i`W #$IfgdW $IfgdsXJOkdP"$$Ifl40y,*4 lalf4 $IfgdsXJ<kd!$$Ifl4py,y,4 lalf4  ~lcc $IfgdsXJ<kd#$$Ifl4py,y,4 lalf4 $IfgdsXJLkd8#$$Ifl0y,*4 lal~PG $IfgdsXJLkd$$$Ifl0y,*4 lal #$IfgdW $IfgdsXJOkd$$$Ifl40y,*4 lalf4$%&'(  stͻͰ͞Ͱ畊ti^j)hp@4Uj`)hp@4Ujb(hp@4Uj'hp@4UjhRh.UhRh.@#j&hp@4hp@4CJUaJhRh.OJQJ#j%hp@4hp@4CJUaJhWh.CJaJjhWh.CJUaJ hRh. hRhsXJhRhWOJQJ$'()MbkdR&$$Ifl4FPy,)    4 lalf4 $Ifgd. $Ifgd 1\<kdZ%$$Ifl4py,y,4 lalf4 !-bkd($$Ifl4F'y,t"s    4 lalf4 $$Ifa$gdmbkdd'$$Ifl4F!y,.     4 lalf4!"s~A<kd*$$Ifl4py,y,4 lalf4 $Ifgd 1\bkdH*$$Ifl4Ft"y,     4 lalf4 $$Ifa$gdm $Ifgdm&(*,@BDNPRT  $&vzɻЭɢɔЭynj"/hp@4Uj.hp@4UhRh.H*hRh.5jX-hWhWUhRhWOJQJjhp@4UmHnHuj+hWhWU hWhWjhWhWU hRhWhRh.OJQJ hRh.jhRh.U)&(*RTVG> $Ifgd 1\Lkd,$$Ifl0y,*4 lal #$IfgdW $Ifgd 1\Okd0+$$Ifl40y,*4 lalf4 $Ifgd 1\VXZ]T #$IfgdWOkd,$$Ifl40y,*4 lalf4 $$Ifa$gdh $Ifgd 1\<kd,$$Ifl4py,y,4 lalf4 "$&(PDDD $$Ifa$gdhOkd:.$$Ifl4p0y,*4 lalf4 $IfgdzeT $Ifgd 1\Lkd-$$Ifl0y,*4 lal=4 $Ifgd 1\Lkd0$$Ifl0y,*4 lal #$IfgdW $Ifgd 1\bkd/$$Ifl4Fry,    4 lalf4fhjl ƿџƿёƿуƿ{hRh.5j<5hWhWUj3hWhWUj1hWhWU hRhWhRh.OJQJ hRh.hRhWOJQJ hWhWjhp@4UmHnHujhWhWUj 0hWhWU/fhji`W #$IfgdW $Ifgd 1\Okd`1$$Ifl40y,*4 lalf4 $Ifgd 1\<kd1$$Ifl4py,y,4 lalf4lcc $Ifgd 1\<kd2$$Ifl4py,y,4 lalf4 $Ifgd 1\LkdH2$$Ifl0y,*4 lalPG $Ifgd 1\Lkd3$$Ifl0y,*4 lal #$IfgdW $Ifgd 1\Okd3$$Ifl430y,*4 lalf4i`W #$IfgdW $Ifgd\Okd4$$Ifl40y,*4 lalf4 $Ifgd\<kdj4$$Ifl4py,y,4 lalf4l`` $$Ifa$gd&<kd6$$Ifl4y,y,4 lalf4 $Ifgd&Lkd5$$Ifl0y,*4 lal SJA #$IfgdW $Ifgd&Okd6$$Ifl4X0y,*4 lalf4 $$Ifa$gd&Okd|6$$Ifl40y,*4 lalf4    !!!!!!!!!!!####"###$ $ $$$$$$%%%%"%$%&%(%,%P%%%g&h&&&'ƿџƿёƿуƿ{hRh.5jn<hWhWUj:hWhWUj 9hWhWU hRhWhRh.OJQJ hRh.hRhWOJQJ hWhWjhp@4UmHnHujhWhWUj^7hWhWU0     !l`` $$Ifa$gd]<kd@8$$Ifl4py,y,4 lalf4 $Ifgd&Lkd7$$Ifl0y,*4 lal!!!!!!PG $Ifgd]Lkd9$$Ifl0y,*4 lal #$IfgdW $Ifgd#&Okd8$$Ifl430y,*4 lalf4!!!###$f]T #$IfgdW $IfgdxSkOkdL:$$Ifl400y,*4 lalf4 $$Ifa$gdTjT<kd9$$Ifl4py,y,4 lalf4$$$$$$lcc $IfgdxSk<kd;$$Ifl4py,y,4 lalf4 $IfgdTjTLkd.;$$Ifl0y,*4 lal$$$&%(%*%PG $IfgdxSkLkd<$$Ifl0y,*4 lal #$IfgdW $IfgdxSkOkd;$$Ifl40y,*4 lalf4*%,%2%%%%?&g&fOkd=$$Ifl40y,*4 lalf4 $$Ifa$gd#&<kdP=$$Ifl4y,y,4 lalf4g&h&i&&&&'VOkd>$$Ifl40y,'4 lalf4 $IfgdB;Okd">$$Ifl40y,*4 lalf4'''k'l'm''VOkdx?$$Ifl40y,'4 lalf4 $IfgdB;Okd?$$Ifl40y,'4 lalf4''k'l'''''I(J(k(l(((4)5)o)p)'*(*,,,,&-(-*-,-@-B-D-N-P-R-T-X-n-p---......//// ///ܹծjfHhp@4UjGhp@4UjhRh.UhRh.5hRhWOJQJjhp@4UmHnHujDhWhWU hWhWjhWhWU hRhW hRh.hRh.OJQJ4''''''I(VOkd`@$$Ifl40y,'4 lalf4 $Ifgdp<Okd?$$Ifl40y,'4 lalf4I(J(K(k(l(m((VOkdHA$$Ifl40y,'4 lalf4 $IfgdFtsOkd@$$Ifl40y,'4 lalf4(((4)5)6)o)VMM $IfgdOkd0B$$Ifl40y,*4 lalf4 $IfgdSRnOkdA$$Ifl40y,'4 lalf4o)p)q)'*(*)*,VJJ $$Ifa$gdSRnOkdC$$Ifl40y,*4 lalf4 $IfgdSRnOkdB$$Ifl40y,*4 lalf4,,,,,,&-VOkdC$$Ifl40y,*4 lalf4 $Ifgd ZqOkdC$$Ifl4X0y,*4 lalf4&-(-*-R-T-V-PG $IfgdJP LkdVE$$Ifl0y,*4 lal #$IfgdW $IfgdOkdnD$$Ifl40y,*4 lalf4V-X-^-n-p-r--f]] $IfgdJP Okd"F$$Ifl40y,*4 lalf4 $$Ifa$gdJP <kdE$$Ifl4y,y,4 lalf4---....VJ $$Ifa$gdZOkd G$$Ifl40y,*4 lalf4 $IfgdJP OkdF$$Ifl40y,*4 lalf4...p/q/r/0VJJ $$Ifa$gdZOkdI$$Ifl40y,*4 lalf4 $IfgdJP Okd~G$$Ifl40y,*4 lalf4//D/E/S/T/U/[/\/j/k/l/p/q/001111112 2 22224262h3j33344M4N44444 5 525354555?5źźhRh.5hRhWOJQJjhp@4UmHnHujKhWhWU hWhWjhWhWU hRhWhRh.OJQJjNIhp@4UjHhp@4U hRh.jhRh.U00001112SJA #$IfgdW $IfgdJP OkdJ$$Ifl4X0y,*4 lalf4 $$Ifa$gdZOkd6J$$Ifl40y,*4 lalf42222242l`` $$Ifa$gdJP <kdK$$Ifl4y,y,4 lalf4 $IfgdJP LkdK$$Ifl0y,*4 lal426282h3j3l33SJJ $IfgdJP OkdL$$Ifl40y,*4 lalf4 $$Ifa$gdJP OkdRL$$Ifl40y,*4 lalf4333444M4VOkdM$$Ifl40y,'4 lalf4 $IfgdJP Okd4M$$Ifl40y,*4 lalf4M4N4O44444VOkdN$$Ifl40y,'4 lalf4 $IfgdJP OkdN$$Ifl40y,'4 lalf4444 5 5 525VOkdxO$$Ifl40y,'4 lalf4 $IfgdJP OkdO$$Ifl40y,'4 lalf4253545666PG $IfgdJP LkdP$$Ifl0y,'4 lal #$IfgdW $IfgdJP OkdO$$Ifl40y,'4 lalf4?5@56 6 666&6(666666666666`7b7d7f7z7|7~777777888888&8(8*8,888888ƿџƿёƿуƿjUhWhWUj>J>K>{>|>>>>> ? ?e?ƿџƿёƿhRh.5j [hWhWUjXYhWhWU hRhWhRh.OJQJ hRh.hRhWOJQJ hWhWjhp@4UmHnHujhWhWUjWhWhWU688888J9lcc $IfgdJP <kdX$$Ifl4py,y,4 lalf4 $IfgdJP LkdX$$Ifl0y,'4 lalJ9L9N9v9x9z9PG $IfgdJP LkdY$$Ifl0y,'4 lal #$IfgdW $IfgdJP OkdX$$Ifl40y,'4 lalf4z9|9~94:6:8:`:i`W #$IfgdW $IfgdJP OkdZ$$Ifl40y,'4 lalf4 $IfgdJP <kd:Z$$Ifl4py,y,4 lalf4`:b:d:f:n::l`` $$Ifa$gdJP <kd[$$Ifl4y,y,4 lalf4 $IfgdJP Lkd[$$Ifl0y,'4 lal:::O<P<Q<SJ $IfgdJP Okd\$$Ifl400y,*4 lalf4 $$Ifa$gdJP OkdL\$$Ifl40y,*4 lalf4Q<R<S<v<w<x<<i`` $Ifgd}COkd]$$Ifl40y,*4 lalf4 $IfgdJP <kd.]$$Ifl4py,y,4 lalf4<<<#=$=%==VOkdt^$$Ifl40y,'4 lalf4 $Ifgd}COkd^$$Ifl40y,'4 lalf4===>>>J>VOkd\_$$Ifl40y,'4 lalf4 $Ifgd}COkd^$$Ifl40y,'4 lalf4J>K>L>{>|>}>>VOkdD`$$Ifl40y,*4 lalf4 $Ifgd}COkd_$$Ifl40y,'4 lalf4>>>>>> ?VOkd,a$$Ifl40y,'4 lalf4 $Ifgd}COkd`$$Ifl40y,'4 lalf4 ? ? ?e?f?g??VOkdb$$Ifl4 0y,'4 lalf4 $Ifgd}COkda$$Ifl40y,'4 lalf4e?f???@@^A`AbAdAxAzA|AAAAAAAABB8B:B,C.C0C2CFCHCJCTCVCXCZCBDDDFDHD\D^D`DjDlDnDpDDDEEEEEܹծ՘ܹծՊܹծjhhWhWUjfhWhWUhRh.5hRhWOJQJjhp@4UmHnHujchWhWU hWhWjhWhWU hRhW hRh.hRh.OJQJ4???@@@^ASJJ $Ifgd}COkdb$$Ifl40y,'4 lalf4 $$Ifa$gd}COkdb$$Ifl40y,'4 lalf4^A`AbAAAAPG $Ifgd}(gLkdRd$$Ifl0y,'4 lal #$IfgdW $Ifgd}(gOkdjc$$Ifl40y,'4 lalf4AAAAAABf]] $Ifgd}(gOkde$$Ifl40y,*4 lalf4 $$Ifa$gd}(g<kdd$$Ifl4y,y,4 lalf4BBB8B:BB>D>F>Z>\>^>h>j>l>n>*?,?.?0?D?F?H?R?T?V?X?????@@@ @ƿƿƿѩƿƿћƿƿэƿƿj hWhWUjX~hWhWUj|hWhWUjzhWhWUhRhW5 hRhWhRhWOJQJ hWhWjhp@4UmHnHujhWhWUjxhWhWU2z<|<<<<<=f]] $IfgdJsOkdz$$Ifl40y,*4 lalf4 $$Ifa$gdx-,<kdy$$Ifl4y,y,4 lalf4======PG $Ifgd'*CLkdd{$$Ifl0y,*4 lal #$IfgdW $IfgdJsOkd|z$$Ifl40y,*4 lalf4===@>B>D>l>i`W #$IfgdW $IfgdJsOkd0|$$Ifl40y,*4 lalf4 $IfgdJs<kd{$$Ifl4y,y,4 lalf4l>n>p>r>t>*?lcc $IfgdJs<kd}$$Ifl4py,y,4 lalf4 $Ifgd'*CLkd}$$Ifl0y,*4 lal*?,?.?V?X?Z?PG $Ifgd'*CLkd~$$Ifl0y,*4 lal #$IfgdW $IfgdJsOkd}$$Ifl40y,*4 lalf4Z?\?^????$@i`W #$IfgdW $IfgdJsOkd$$Ifl40y,*4 lalf4 $IfgdJs<kd:$$Ifl4py,y,4 lalf4 @"@$@&@@@@@@@@@@@@C C CC"C$C&C0C2C4C6CDDDD0D2D4D>D@DBDDDHDDDxFzF|F~FFFFFFFF@GBGDGFGZGۛjPhWhWUhRhW5j(hWhWUjthWhWUjhp@4UmHnHujhWhWU hRhWhRhWOJQJ hWhWjhWhWU7$@&@(@*@,@@lcc $IfgdJs<kd$$Ifl4py,y,4 lalf4 $Ifgd'*CLkd$$Ifl0y,*4 lal@@@@@@PG $Ifgd'*CLkd4$$Ifl0y,*4 lal #$IfgdW $IfgdJsOkdL$$Ifl40y,*4 lalf4@AAC C C4C]TK #$IfgdW $IfgdJsOkd$$Ifl400y,*4 lalf4 $$Ifa$gdJs $IfgdJs<kd$$Ifl4py,y,4 lalf44C6C8C:CHPG $IfgdfLkd,$$Ifl0y,*4 lal #$IfgdW $IfgdfOkdD$$Ifl40y,*4 lalf4>H@HHHhHjHlH2If]] $IfgdfOkd$$Ifl40y,*4 lalf4 $$Ifa$gdf<kd$$Ifl4y,y,4 lalf42I4I6I^I`IbIPG $Ifgd'*CLkdT$$Ifl0y,*4 lal #$IfgdW $IfgdfOkdl$$Ifl40y,*4 lalf4bIdIfIIIIJi`W #$IfgdW $IfgdfOkd $$Ifl40y,*4 lalf4 $Ifgdf<kd$$Ifl4py,y,4 lalf4JJJJJJlcc $Ifgdf<kdv$$Ifl4py,y,4 lalf4 $Ifgd'*CLkd$$Ifl0y,*4 lalJJJJJJPG $Ifgd'*CLkd$$Ifl0y,*4 lal #$IfgdW $IfgdfOkdԏ$$Ifl40y,*4 lalf4JJJJKKKKKLLLLMM M"M6M8M:MDMFMHMJMNNN N4N6N8NBNDNFNHNLNNNROTOVOXOlOnOpOzO|O~OOOOOOOjhWhWUjjhWhWUjhp@4UmHnHujhWhWUhRhW5hRhW>* hRhWhRhWOJQJ hWhWjhWhWU5JJJKKKi` $IfgdfOkd$$Ifl40y,*4 lalf4 $Ifgdf<kd*$$Ifl4py,y,4 lalf4KKKLLLLf]] $IfgdfOkdZ$$Ifl40y,*4 lalf4 $$Ifa$gdf<kd$$Ifl4y,y,4 lalf4LLLMM MHMVMD #$IfgdW $IfgdfOkdB$$Ifl40y,*4 lalf4 $IfgdfOkdΒ$$Ifl40y,*4 lalf4HMJMLMNMPMNlcc $Ifgdf<kd$$Ifl4py,y,4 lalf4 $Ifgd'*CLkd*$$Ifl0y,*4 lalNNNFNHNJNPG $Ifgd}Lkdޕ$$Ifl0y,*4 lal #$IfgdW $IfgdfOkd$$Ifl40y,*4 lalf4JNLNTNNNNROf]] $Ifgd}Okd$$Ifl40y,*4 lalf4 $$Ifa$gd}<kdL$$Ifl4y,y,4 lalf4ROTOVO~OOOPG $Ifgd'*CLkd$$Ifl0y,*4 lal #$IfgdW $Ifgd}Okd$$Ifl40y,*4 lalf4OOOOOO Pi`W #$IfgdW $Ifgd}OkdҘ$$Ifl40y,*4 lalf4 $Ifgd}<kdt$$Ifl4py,y,4 lalf4OOOP P PPnPpPrPtPPPPPPPPPPPRRR RR R"R,R.R0R2RRRRRSSSSS S"S&S\S^SSSVVXVZV\VpVƿƿѱƿƿƿћƿƿэƿƿƿƿjОhWhWUjhWhWUhRhW5jhWhWU hRhWhRhWOJQJ hWhWjhp@4UmHnHujhWhWUjFhWhWU4 PPPPPnPlcc $Ifgd}<kd($$Ifl4py,y,4 lalf4 $Ifgd'*CLkd$$Ifl0y,*4 lalnPpPrPPPPPG $Ifgd}Lkdn$$Ifl0y,*4 lal #$IfgdW $Ifgd}Okd$$Ifl40y,*4 lalf4PPPPPPRfOkd:$$Ifl40y,*4 lalf4 $$Ifa$gd}<kdܛ$$Ifl4y,y,4 lalf4RRR0R2R4RPG $Ifgd'*CLkd$$Ifl0y,*4 lal #$IfgdW $Ifgd}Okd$$Ifl40y,*4 lalf44R6R8RRRR Si`W #$IfgdW $Ifgd}Okd\$$Ifl40y,*4 lalf4 $Ifgd}<kd$$Ifl4py,y,4 lalf4 S"S$S&S.S\Sl`` $$Ifa$gd}<kd$$Ifl4y,y,4 lalf4 $Ifgd}LkdD$$Ifl0y,*4 lal\S^S`SSSSVVSJ> $$Ifa$gd'*C $Ifgd'*COkd$$Ifl4 0y,*4 lalf4 $$Ifa$gd}Okd$$Ifl40y,*4 lalf4VVXVZVVVVPG $Ifgd'*CLkdڡ$$Ifl0y,*4 lal #$IfgdW $Ifgd}Okd$$Ifl400y,*4 lalf4pVrVtV~VVVVVVVVVWW WWWWXX|Y~YYYYYYYYYYYYZZ\ZZZZZZZZZZZZX[Z[\[^[r[ƿƿѱƿƿƿѣƿƿƿэƿƿjdhWhWUhRhW5jBhWhWUjhWhWU hRhWhRhWOJQJ hWhWjhp@4UmHnHujhWhWUjfhWhWU2VVVVVVWi`W #$IfgdW $Ifgd}Okd$$Ifl40y,*4 lalf4 $Ifgd}<kdH$$Ifl4py,y,4 lalf4WWWWWXlcW $$Ifa$gd'*C $Ifgd}<kd$$Ifl4py,y,4 lalf4 $Ifgd'*CLkd$$Ifl0y,*4 lalXXX|Y~YYYVMD #$IfgdW $Ifgd}OkdΤ$$Ifl40y,*4 lalf4 $Ifgd'*COkdZ$$Ifl40y,*4 lalf4YYYYYZZl`` $$Ifa$gd'*C<kd$$$Ifl4y,y,4 lalf4 $Ifgd'*CLkd$$Ifl0y,*4 lalZZ\Z^ZZZZZSJA #$IfgdW $Ifgd'*COkd$$Ifl4 0y,*4 lalf4 $$Ifa$gd'*COkd$$Ifl40y,*4 lalf4ZZZZZX[l`` $$Ifa$gdr@<kdF$$Ifl4py,y,4 lalf4 $IfgdJsLkdا$$Ifl0y,*4 lalX[Z[\[[[[PG $Ifgdr@Lkd$$Ifl0y,*4 lal #$IfgdW $Ifgdr@Okd$$Ifl4 0y,*4 lalf4r[t[v[[[[[\\\\\\\\\\]]]`]b]~]]]]]]]]]]]]]]]^ ^&^(^*^n^p^ƿƿѱƿƿynjhp@4Ujrhp@4Ujhp@4Ujhp@4UjhRhWUhRhW5OJQJjhWhWU hRhWhRhWOJQJ hWhWjhp@4UmHnHujhWhWUjhWhWU+[[[\\\\ZQH #$IfgdW $Ifgdr@OkdR$$Ifl40y,*4 lalf4 $$Ifa$gdzeT $$Ifa$gdr@<kd$$Ifl4py,y,4 lalf4\]]]]]]PD $$Ifa$gdzeTOkd$$Ifl40y,*4 lalf4 $IfgdzeT $Ifgdr@Lkd4$$Ifl0y,*4 lal]]]j^l^n^^F= #$IfgdWOkdZ$$Ifl40y,*4 lalf4$  $Ifa$gdghO $Ifgdr@Okd$$Ifl40y,*4 lalf4p^^^^^^^^^^^^^^^^^^___$_&_(_2_4_6_8_H_J_^_`_b_l_n_p_r_____________øjjhWhWUjrhWhWUjzhWhWUjhWhWUhRhWOJQJhRhW5 hRhWjhp@4UmHnHujhWhWUjήhWhWU hWhW0^^^^^^l`` $$Ifa$gdr@<kd$$Ifl4y,y,4 lalf4 $Ifgdr@LkdB$$Ifl0y,*4 lal^^^^^_:_kd$$IflFy,$    4 lal #$IfgdW $$Ifa$gdr@Okd$$Ifl40y,*4 lalf4___6_8_:_H_p__kd$$IflFy,*$    4 lal #$IfgdW $IfgdgSp_r_t____-_kd޳$$IflFy,*$    4 lal #$IfgdW $IfgdgS_kd$$IflFy,*$    4 lal______`0`_kdִ$$IflF y,     4 lal #$IfgdW $IfgdgS_______` `` `"`,`.`0`2`@`B`V`X`Z`d`f`h`j`n````````````aaaaa&a(a*a,aPaƿѱƿѣƿƿэƿv؅ƿjhWUhWjhWUjhWhWUhRhW5jRhWhWUjZhWhWU hRhWhRhWOJQJ hWhWjhp@4UmHnHujhWhWUjbhWhWU.0`2`4`@`h`j`-_kdƶ$$IflFy,*$    4 lal #$IfgdW $IfgdgS_kdε$$IflFy,*$    4 lalj`l`n`v``````]T #$IfgdWOkd$$Ifl40y,*4 lalf4 $$Ifa$gdgS<kdJ$$Ifl4y,y,4 lalf4 $IfgdgS```a*a #$IfgdW $$Ifa$gdgS_kd$$IflFby,%    4 lal*a,a.aPaxa #$IfgdW $$Ifa$gdgS_kd~$$IflFby,%    4 lalPaRafahajatavaxazaaaaaaaaaaaabbbbbbbbbc cc c"c,c.c0c2c6c8cjclcxczcƿƿƿƿƿz hc80Jjhc80JUhc8 hRh(VjnhWhWUjhWhWUjhWhWU hRhWhRhWOJQJjhp@4UmHnHujhWhWU hWhWjhWhWU+xaza|aaa #$IfgdW $$Ifa$gdgS_kdv$$IflFpy, $    4 lalaaaab #$IfgdW $$Ifa$gdgS_kdn$$IflFby,%    4 lalbbbbb $Ifgdp< $$Ifa$gdgS_kdf$$IflF2 y,pG"    4 lalbbbc0c #$IfgdW $$Ifa$gdgSbkd$$Ifl4 Ft"y,      4 lalf40c2c4c6c8cccccYTRPPTgd(V<kdf$$Ifl4py,y,4 lalf4 $Ifgdr@_kd$$IflF~ y,"    4 lalzc|c~cccc   & ( * > @ B L N P R f h v x z                     ( ϹӫϠϕϊtjhYqUjNhYqUjhYqUjhYqUjYhYqUjhYqUmHnHujhYqUjľhYqUhYqjhYqU hRh(VhF2yhc8jhc80JUhF2y0JmHnHu,.&P:p / =!"#$%\$$Ifl!vh5y,#vy,:V l4,5y,4alf4tDText4$$Ifl!vh55$5#v#v$#v:V l4,55$54alf4tDText3tDText1$$Ifl!vh5 5\ 55 5#v #v\ #v#v #v:V l4,5 5\ 55 54alf4\$$Ifl!vh5y,#vy,:V l4E,5y,4alf4\$$Ifl!vh5y,#vy,:V l4x,5y,4alf4\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText5l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4jDl$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4jDl$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4Df Dropdown1 YesNoN/A$$Ifl!vh555)#v#v#v):V l4,555)4alf4Df YesNoN/A$$Ifl!vh55.5 #v#v.#v :V l4,55.5 4alf4tDeCheck1tDeCheck2$$Ifl!vh55t"5s#v#vt"#vs:V l4,55t"5s4alf4tDeCheck1tDeCheck2$$Ifl!vh555 #v#v#v :V l4,555 4alf4\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4alr$$Ifl!vh55*#v#v*:V l4p,55*4alf4tDeCheck1tDeCheck2$$Ifl!vh555#v#v#v:V l4,5554alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l43,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l4X55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4355*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4055*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l455*4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l4X55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDeCheck1tDeCheck2tDeCheck1tDeCheck2r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l455*4alf4l$$Ifl!vh55*#v#v*:V l4X55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l455*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l4055*4alf4\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4r$$Ifl!vh55'#v#v':V l4 ,55'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4l$$Ifl!vh55'#v#v':V l455'4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4r$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4alr$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4alr$$Ifl!vh55'#v#v':V l4,55'4alf4tDText7l$$Ifl!vh55'#v#v':V l,55'4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l455*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l40,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l455*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4r$$Ifl!vh55*#v#v*:V l40,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l4 55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4l$$Ifl!vh55*#v#v*:V l455*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4alr$$Ifl!vh55*#v#v*:V l4,55*4alf4tDeCheck3tDeCheck4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDeCheck5tDeCheck6r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7l$$Ifl!vh55*#v#v*:V l,55*4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7$$Ifl!vh555$#v#v#v$:V l,555$4altDText7$$Ifl!vh55*5$#v#v*#v$:V l,55*5$4altDText7$$Ifl!vh55*5$#v#v*#v$:V l,55*5$4altDText7$$Ifl!vh55*5$#v#v*#v$:V l,55*5$4altDText7$$Ifl!vh555 #v#v#v :V l,555 4altDText7$$Ifl!vh55*5$#v#v*#v$:V l,55*5$4altDText7$$Ifl!vh55*5$#v#v*#v$:V l,55*5$4al\$$Ifl!vh5y,#vy,:V l4,5y,4alf4r$$Ifl!vh55*#v#v*:V l4,55*4alf4tDText7$$Ifl!vh555%#v#v#v%:V l,555%4aljD$$Ifl!vh555%#v#v#v%:V l,555%4altDText7$$Ifl!vh555 $#v#v#v $:V l,555 $4altDText7$$Ifl!vh555%#v#v#v%:V l,555%4altDText7$$Ifl!vh55p5G"#v#vp#vG":V l,55p5G"4al$$Ifl!vh55 5 #v#v #v :V l4 55 5 4alf4tDText7$$Ifl!vh555"#v#v#v":V l,555"4al\$$Ifl!vh5y,#vy,:V l4p,5y,4alf4DAddress1 UppercasedEnter the Addressee's mail address (street address, PO Box, etc., where the mail will be delivered). ClientCityDBureau$8@8 '*CNormal_HmH sH tH B@B Heading 3 $<5CJDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List @O@ BLANKLINEd CJOJQJJOJ Captions 7pt ^ CJOJQJNON Captions 8pt ^CJOJQJkHNO"N Captions 9pt ^CJOJQJkHJO2J Captions 10pt ^ OJQJkH< @B< Footer   CJOJQJLORL Form Title 10pt$a$ OJQJkHPObP Form Title 11pt$a$CJOJQJkHPOrP Form Title 12pt$a$CJOJQJkH\O\ Form Title 12pt Bld$a$5CJOJQJkHHOH User Input ^5OJQJkHVOV Letter Text 10pt$^a$ OJQJkH@O@ Letter Text 11ptCJZOZ Letter Text 12pt$^a$CJOJQJkH4@4 Header  !.)@. Page NumberVOV (VCaptions 9pt Bold dL CJOJQJXOX (VForm Title 10pt Bld d8( 5OJQJPOP (VUser Input 10pt!d8(OJQJFV@!F Z]FollowedHyperlink >*B* phjO2j c8_Form Fills Arial 12#d^5CJOJQJ^JaJ>()6JKLcw()*+,567KLMNOefg{|}~&'(),hij~01234LMNbcdef   !"#$%abcwxyz}:;<PQRSTopq'() !"s   ) * + , - y z {  3 4 5 I J K L M [ \ ] q r s t w        $%&:;<=>rOPQ !"|}~ghiZ[\456tuv-./OPQIJK      =>?vwx"#$89:;<DEF012FGHIJ~KLMabcdhrst !!!T!U!V!!!!3"4"5"{"|"}"""""""###:#;#<#######z${$|$$$$$$$$$% % %9%:%;%M%N%O%%%%%%%%%R&S&T&h&i&j&k&l&&&&&&&'''''='>'?'S'T'U'V'W'u'v'w''''''''''''''Y(Z([(}(~(((((((((((((H)I)J)^)_)`)***+*,*-*x*y*z******V+W+X+l+m+n+o+s+++++++,,,,,Q,R,S,g,h,i,j,k,,,,,,,,,--.-/-C-D-E-F-G---------......../R/S/T/U/Y////m0n0o000000000000008191:1N1O1P1Q1U1e1f1g111111111$2%2&2:2;2<2=2>2222222223333 3:3;3<333333333333>4?4@4T4U4V4W4[444444444444!5"5#5758595:5;5h5i5j5~55555555364656I6J6K6L6M666666666666*7+7,7\8]8^8r8s8t8u8v888888888}9~99999:::: :^:_:`:::::::::::::::::;;;;;;;;; <<<f<g<h<|<}<~<<<<<<<<<<<<<<<<<<<====,=-=.=5=I=J=K=Q=e=f=g=h=l=================>>>&>:>;><>>>>>>>>>>>>>>0x 0| 0x #0 0x 0| 0x #0 0x 0 0x 0| 0x 0| 0x0x!0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 0x #0 0| 0x 0| 0x 0x 0| 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 08 0< 08 08 08 0< 08 08 08 0< 08 08 08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 08 0< 08 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 0808 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 08 0< 08 #08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 #08 0< 08 08 0< 08 08 0< 08 08 0< 08 #08 0< 08 0< 08 08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 0< 08 08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 08 #08 0< 08 08 08 0< 08 08 #08 0< 08 0< 0@0@00L4()6JKLcw()*+,567KLMNOefg{|}~&'(),hij~01234LMNbcdef   !"#$%abcwxyz}:;<PQRSTopq'() !"s   ) * + , - y z {  3 4 5 I J K L M [ \ ] q r s t w        $%&:;<=>rOPQ !"|}~ghiZ[\456tuv-./OPQIJK      =>?vwx"#$89:;<DEF012FGHIJ~KLMabcdhrst !!!T!U!V!!!!3"4"5"{"|"}"""""""###:#;#<#######z${$|$$$$$$$$$% % %9%:%;%M%N%O%%%%%%%%%R&S&T&h&i&j&k&l&&&&&&&'''''='>'?'S'T'U'V'W'u'v'w''''''''''''''Y(Z([(}(~(((((((((((((H)I)J)^)_)`)***+*,*-*x*y*z******V+W+X+l+m+n+o+s+++++++,,,,,Q,R,S,g,h,i,j,k,,,,,,,,,--.-/-C-D-E-F-G---------......../R/S/T/U/Y////m0n0o000000000000008191:1N1O1P1Q1U1e1f1g111111111$2%2&2:2;2<2=2>2222222223333 3:3;3<333333333333>4?4@4T4U4V4W4[444444444444!5"5#5758595:5;5h5i5j5~55555555364656I6J6K6L6M666666666666*7+7,7\8]8^8r8s8t8u8v888888888}9~99999:::: :^:_:`:::::::::::::::::;;;;;;;;; <<<f<g<h<|<}<~<<<<<<<<<<<<<<<<<<<====,=-=.=5=I=J=K=Q=e=f=g=h=l=================>>>&>:>;><>>>>>>>>>>>0x 0| 0x #0x 0x 0| 0x #0x 0x 0x 0x 0| 0x 0| 0x0x!0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0x 0| 0x 0x 0x 0| 0x 0x 0x 0| 0x 0x 0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0x 0| 0x 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| @0x @0x @0| 0x 0x 0| @0x @0x @0| 0x 0x 0| @0x @0x @0| @0x @0| @0x @0x @0| @0x @0x @0| @0x @0| @0x @0x @0| @0x @0x @0| @0x @0x @0| @0x @0| @0x @0x @0| @0x @0x @0| @0x @0| @0x @0x @0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| 0x 0x 0| @0x @0x @0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x #0x 0| 0x 0x 0| 0x 0x 0| 0x 0x 0| 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0| 0x 0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x #0x 0| 0x 0x 0x 0| 0x 0x #0x 0| 0x 0| X%%%(6BHcou &7CIgsy$jv|(.NZ` cou<HNq}% s ! ' {   5 A G ] i o    &28$4;Kw$062>DMY_$$$%%%T&`&f&& ''?'K'Q'w''''''(((J)V)\)*#*)*z***X+d+j++ ,,S,_,e,,,,/-;-A----...>/J/P/o0{00000:1F1L1111&22282222333@4L4R4444#5/555j5v5|556A6G6666^8j8p888899:::::::;;;;;;<<.<5<E<h<t<z<<<<<<<<<<<<==$=*=5=A=G=Q=]=c===========> >&>2>8>>>>>FFFFFFFFFFFFFFFFFFFFFFS$S$G$G$G$G$FFG$G$FFFFFFFFFG$G$G$G$FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFG$G$G$G$FFFFFFFFFFFFFF "(!8@0(  B S  ?Text4Text3Text1Text5Text7 OLE_LINK1Check7 Dropdown1Check1Check2Check3Check4Check5Check67dh ;;<6<> Ivz&(; </<F<>6Icv'7Jgz%j}/Na  cv<Oq ( { 5 H ] p   &9$72EM`$$%%T&g&&'?'R'w''''((J)])***z**X+k++,S,f,,,/-B---..>/Q/o0000:1M111&2922233@4S444#565j5}556H666^8q8889:::::;;<-</<0<3<G<I<>>>>>6Icv'7Jgz%j}/Na  cv<Oq ( { 5 H ] p   &9$72EM`$$%%T&g&&'?'R'w''''((J)])***z**X+k++,S,f,,,/-B---..>/Q/o0000:1M111&2922233@4S444#565j5}556H666^8q8889:::::;;<<e<>>>>>6Icv'7Jgz%j}/Na  cv<Oq ( { 5 H ] p   &9$72EM`$$%%T&g&&'?'R'w''''((J)])***z**X+k++,S,f,,,/-B---..>/Q/o0000:1M111&2922233@4S444#565j5}556H666^8q8889:::::;;-<.<D<E<h<{<<<<<<<<==+=5=H=Q=d========>&>9>>>>>>>>>>>> @dcf@Z].zd.m J} p R4:UJP B!!#x/#[*(,x-,. i/*3`3p@4c8A98;=L>@~?@r@'*C+DTHsXJ4OghO PhQuQgSzeTTjTUW[ 1\>bpAe}(ghbJkxSk:mSRn ZqpsFtsLyF2yz7kzTAmT&fGj0;Z?]@5p<`X}B;c]_s>4W(V\Js%}C #&xqth@5F(\(()6JKLcw()*+,567KLMNOefg{|}~&'(),hij~01234LMNbcdef   !"#$%abcwxyz}:;<PQRSTopq'() !"s   ) * + , - y z {  3 4 5 I J K L M [ \ ] q r s t w        $%&:;<=>OPQ !"|}~ghiZ[\456tuv-./OPQIJK      =>?vwx"#$89:;<DEF012FGHIJ~KLMabcdhrst !!!T!U!V!!!!3"4"5"{"|"}"""""""###:#;#<#######z${$|$$$$$$$$$% % %9%:%;%M%N%O%%%%%%%%%R&S&T&h&i&j&k&l&&&&&&&'''''='>'?'S'T'U'V'W'u'v'w''''''''''''''Y(Z([(}(~(((((((((((((H)I)J)^)_)`)***+*,*-*x*y*z******V+W+X+l+m+n+o+s+++++++,,,,,Q,R,S,g,h,i,j,k,,,,,,,,,--.-/-C-D-E-F-G---------......../R/S/T/U/Y////m0n0o000000000000008191:1N1O1P1Q1U1e1f1g111111111$2%2&2:2;2<2=2>2222222223333 3:3;3<333333333333>4?4@4T4U4V4W4[444444444444!5"5#5758595:5;5h5i5j5~55555555364656I6J6K6L6M666666666666*7+7,7\8]8^8r8s8t8u8v888888888}9~99999:::: :^:_:`:::::::::::::::::;;;;;;;;; <<<f<g<h<|<}<~<<<<<<<<<<<<<<<<<<<====,=-=.=5=I=J=K=Q=e=f=g=h=l=================>>>&>:>;><>>>>>>>>>>>V00V00  Spell Check Spell CheckvQ+vQ+vQ+vQ+vQ+ 0 (  Spell CheckForms Spell Check2Module1.FormsSpellCheck2gTemplateProject.MyInfo.Main(TemplateProject.Module1.FormsSpellCheck2TEMPLATEPROJECT.MYINFO.MAIN(TEMPLATEPROJECT.MODULE1.FORMSSPELLCHECK2@ CHCC`  33331111 1$1%1&1'1(>`` ` `````,@````<@` `D@`$`L@`,`\@`2`h@`6`8`:`x@`@`B`D`F`6UnknownG: Times New Roman5Symbol3& : Arial?5 z Courier New"hFFvJʆ_ n5 q_ n5 qr ci#4d>>a3QH?(V2BCAL-3130, Initial Foster Home/Adoption EvaluationComp AdministratorlL@LNormal#CJ OJQJ_HmHnHsH tH uDAD Default Paragraph FontViV  Table Normal :V 44 la (k(Oh+'0 (4 P \ h t4BCAL-3130, Initial Foster Home/Adoption EvaluationComp BCAL-3130Administrator2Microsoft Word 10.0@@*@:j@:j_ n5՜.+,0, hp  State of Michiganq > 3BCAL-3130, Initial Foster Home/Adoption Evaluation Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~N      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`ab^defghijklmnopqrstuvwxyz{|}~o  :?0 !"#$%&'()*+,-./123456789;<=B>@ALDEFGHIJKMOPQRSTUVWXYZ[\]_`abcdefghijklmpqrstuvwxyz{|}~Root Entry Fw#j$Data `1TablecpWordDocument$SummaryInformation(DocumentSummaryInformation8MacrosnY#jnY#jVBA nY#jnY#jdir%MyInfo y3Module1 ( __SRP_0 >  !"#$%&'()*+,-./0123456789:;<=?@ABCDEFGHIJKLMNOPQRSTUVWXYZ\]_acdfhijklmnopqsuvwxyz{|}~!0* pHdTemplateProjectQH@  = | HdJ0 J< 9stdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\WINDOWS\System32\e2.tlb#OLE Automation0MSForms>SFFrms3ED452EE1-E08F-101A-8-02608C4D0BB 4EsEFM20.DLL#Microsoft :" ^ Ob Library/;D1uA00}#0#Gk0 AA0153031-6DFC-47FD-A17B-72A4FA@A1D82C6DOCUME~1\bushd2\L`OCALS\VBE\T.exd;@!.E .`0M OfficOf@ic 12DF8D04@C-5BFAgB -BDE5IAA5421gram Files\CommonhShared\i 105Op 8.0p@%ӈ5»ThisDocumentG *T@iDcuen@ 2 HB1BE,!5""+qMyInfoG MyIf2 ' u! bnodule1Gdnou1rM2  "( 5x"'5uxME(6 << < `@`Enter Personal InformationNormal.MyInfo.Main@  PP P"P$P&P(P*P,P.P0P2P4P6P8P:P<P>08P@E-PBB4`P \W%8xHdJ0$*\Rffff*184a644473 " (08@HPX`hpx &((0*X&(&&((&P$x&$$&$@&h&(N$0$X&&*$"(0PT$$(H hx <468H6864(6`846 4@ 2x 2 4 2 4X : : 2 H ` & 4 6 8 6P 8 6 4 60 8h 4 6 42H2424(:`: "0284p2420P2402 0X..0.0H6x6 ":>PB>F2`:>66P.2::02p62BF` 4 2 & (@ *h .  2 4 X ` p ]x]]]]]]] ]8]P]h]]]]]]]](]@DEFINE DIALOG BOXF,MyInfo DB@Fm ^YourName DB@Hm8^ YourTitle DB@HmP^ YourOffice DB@Hmi^ YourAddress DB@H2xYourCity DB@HT( YourState DB@HFYourZip DB@Hn(AreaCode DB@HP YourPhone DB@H<YourExt DB@Hr(FAXAC DB@HPYourFax DB@H(YourCO DB@H(YourDI DB@H(YourSEC DB@HT(YourUN DB@H(YourWKR DB@Hm^BossName DB@Hm^ BossTitle DB@Hk  /Enter the following information about yourself. DB@d#2 Name: DB@d;2 Title: DB@dR< Office: DB@dkU Address: DB@d City-ST-Zip: DB@d7 Phone: DB@d>% FAX: DB@dCO-DI-SEC-UN-WKR: DB@dK 6Enter the following information about your supervisor. DB@d2 Name: DB@d 2 Title: DB@d X DB@J"X DB@L DB@N]XF D!R!T.P6GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOXxUserInfoName MYINFO.ini D%X P(VUserInfoTitle MYINFO.ini D%X P(ZUserInfoAreaCode MYINFO.ini D%X P("UserInfoPhone MYINFO.ini D%X P(\UserInfoYourExt MYINFO.ini D%X P(&UserInfoFaxAC MYINFO.ini D%X P((UserInfoFax MYINFO.ini D%X P(*UserInfoOffice MYINFO.ini D%X P(^UserInfoAddress MYINFO.ini D%X P(`UserInfoCity MYINFO.ini D%X P(bUserInfoState MYINFO.ini D%X P(dUserInfoZip MYINFO.ini D%X P(fUserInfoCO MYINFO.ini D%X P(hUserInfoDI MYINFO.ini D%X P(jUserInfoSEC MYINFO.ini D%X P(lUserInfoUN MYINFO.ini D%X P(nUserInfoWKR MYINFO.ini D%X P(pUserInfo Boss Name MYINFO.ini D%X P(@UserInfo Boss Title MYINFO.ini D%X P(B,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT P D!r%T'  OK BUTTONWRITE NEW USER INFO IN INI FILEUserInfoName P!V MYINFO.ini DB@tUserInfoTitle P!Z MYINFO.ini DB@tUserInfoAreaCode P!" MYINFO.ini DB@tUserInfoPhone P!\ MYINFO.ini DB@tUserInfoYourExt P!& MYINFO.ini DB@tUserInfoFaxAC P!( MYINFO.ini DB@tUserInfoFax P!* MYINFO.ini DB@tUserInfoOffice P!^ MYINFO.ini DB@tUserInfoAddress P!` MYINFO.ini DB@tUserInfoCity P!b MYINFO.ini DB@tUserInfoState P!d MYINFO.ini DB@tUserInfoZip P!f MYINFO.ini DB@tUserInfoCO P!h MYINFO.ini DB@tUserInfoDI P!j MYINFO.ini DB@tUserInfoSEC P!l MYINFO.ini DB@tUserInfoUN P!n MYINFO.ini DB@tUserInfoWKR P!p MYINFO.ini DB@tUserInfo Boss Name P!@ MYINFO.ini DB@tUserInfo Boss Title P!B MYINFO.ini DB@tGet user info from INI filekeUserInfoName MYINFO.ini D%X' UserInfoTitle MYINFO.ini D%X' orker8UserInfoAreaCode MYINFO.ini D%X' "tricUserInfoPhone MYINFO.ini D%X' $vUnit/UserInfoYourExt MYINFO.ini D%X' &NumbUserInfoFaxAC MYINFO.ini D%X' ( ClieUserInfoFax MYINFO.ini D%X' *UserInfoOffice MYINFO.ini D%X' , SeUserInfoAddress MYINFO.ini D%X' .onڶUserInfoCity MYINFO.ini D%X' 0UserInfoState MYINFO.ini D%X' 2tectDoUserInfoZip MYINFO.ini D%X' 4UserInfoCO MYINFO.ini D%X' 6rUserInfoDI MYINFO.ini D%X' 8esUserInfoSEC MYINFO.ini D%X' :UserInfoUN MYINFO.ini D%X' <HeUserInfoWKR MYINFO.ini D%X' >UserInfo Boss Name MYINFO.ini D%X' @,UserInfo Boss Title MYINFO.ini D%X' B  Update Form with user info Bord WorkerName D%vG workerName  DB@xjddress WorkerTitle D%vG WorkerTitle  DB@xjchWorkerAreaCode D%vGWorkerAreaCode " DB@xj WorkerPhone D%vG WorkerPhone $ DB@xjonWorkerExtension D%vGWorkerExtension & DB@xjmuFaxAC D%vGFaxAC ( DB@xjDat WorkerFax D%vG WorkerFax * DB@xj Countynumber D%vG Countynumber 6 DB@xj District D%vGDIstrict 8 DB@xjGrSection D%vGSECtion : DB@xjteUnit D%vGUNit < DB@xjkeWorker D%vGWorker > DB@xjame2sL CountyName D%vG CountyName , DB@xjStylea CoAddress D%vG CoAddress . DB@xjLefCoCity D%vGCoCity 0 DB@xjCasCoState D%vGCoState 2 DB@xjFCCoZip D%vGCoZip 4 DB@xjUseSupervisorName D%vGSupervisorName @ DB@xj ColSupervisorTitle D%vGSupervisorTitle B DB@xj. Update other Form Fields on Form & Exit Macroon|- Selected$=GetFormResult$ ("CurrentDate")UserD! TheSerialDate = Today() + 14 $ TheDate$ = Date$(TheSerialDate)& SetFormResult "DueDate", TheDate$You) EditGoTo "CreateDate" : UnlinkFieldsri EditGoTo "GranteefirstName"- ToolsProtectDocument .NoReset = 1, .Type = 2Start/ ToolsProtectSection .Section = 2, .Protect = 0fo@d FileClose 2 SelectName = - 1nekpoh`(Attribute VB_Name = "MyInfo" Public Sub Main(X) D.nDescription|Enter Personal rma:zProcDataIInvoke _FuncINoi8l..nADim iRet B  User$ATitleAreaCod-PhonYourExtFax|AC Offic $AddressCitByStat Zip ODILSEB;UN WKRBoss|| 'DEFINE DIALOG BOX WordBasic.BeginDialog 582, 300,} G TextBox 109@ A 5@ 18@ I @ey 56 * 83 _[ 105WDi 2A3321A5r 34 _  | 9 7 @ 1$55E [1 Pi 23` 6i`cV3jFAXAC41e lV1@,CO629 *DI7m pV? UN6z4!l1.yVm23n`~64`'Fz7,, c3z#the followin`g infa@bout ys0elf. ", ׂ !:w5f"bC #1z0@8O$351{1A-ST- u5 abm3r13@? gY  ;"C O-DI-T-U,N-@H47224*; supervisor!a 124f6p6iOKButtY48 8pR21 fCanctel3kEndn ҂dlg!u! As Object: Se$t = CurValues. vGET USER INFO FROMI FILE AND@ PUT I NTOzx.t[GetPrivfileS@@ng$](" "'P:qMY.ini"r hl ? pa"4??>? Mpn_1r &.nAC `axU/-Y??>OMA\C$$a&gp Op | DIpp/-UN0 | {p y QaserInfo", "Boss Name`MYINFO.ini") dlgU.Title = WordBasic.[GetPrivateProfileString$]("t| 'DISPLAY DIALOG BOX AND RESPOTO USER INPUT iRet Dialog.p (If 3-1 Then 'OK BUTTON ?WRI@TE NEW3FO6I FILE xSx wYour ?, - -AreaCod|PhonEExtE@FaxACL+@OfficZ|Address0$ L+gCity ? : |StP  z Zo%  CoCity  ! CoStat$c b CoZip  "Supervi8sor<`, Boss! /Titl% b ' Upd. other  FieldsH on& t Macro Rem" SelA}ed$=G$ ("Curre8ntD9'`Serial = Today() + 14$5()lDure",a"GEditGoTo 0"Cre : Unlink'Grante@efirst3"ToolsProtDocum! .No@et`1, .Type@2/ .8= 2 `0 Else#FileClose D c.@- 1$nd #Sub ME$ L6 LLLLL<(<,<0<4<8<<<P8|0% `k x%x`xHH@t @p @(` @@P @L M@H  0@DO 8 @X4 @p$ @ @ @ @ @ @ @ @0 t@H @` la@xt e @d @T @D @4 @$ @ @  #@ @ 88HdJ0$*\Rffff*1=4a6449c3*\R1*#10b*\R1*#17b*\R1*#c1*\R1*#c6*\R1*#91*\R1*#166*\R1*#10b*\R1*#d4"  .(*)Xx & /W ( *((58  ho]x ! 8'If document is protected, Unprotect it.J:cladd87 B@ectionkPerform Spelling/Grammar check.  !eckGra !(ngk ( !B@  ReProtect the document. ! cladd87 l B@Attribute VB_Name = "Module1" Sub FormsSpellCheck2() Dim x As wdNo Then  9ZPassword:="c@ladd87E nd If'P(erf ing/Gramma8r clK.Op2tBs.vWi thFalse EachIn JsZx.Range.iof>$;;5AlwaysSuggest :=Tru; Next: 'Re the=&EW, n orese&, o:=wdAllowOnlyAbAAeK*srU~~~~~~~~~~~` 22{yK';4   y iQa i  ThisDocumentMyInfoTemplateProjectF@C:\Program Files\Common Files\Microsoft Shared\VBA\VBA6\VBE6.DLLVBA ! I0 F5C:\Program Files\Microsoft Office\Office10\MSWORD.OLBWord Ai@0FC:\WINDOWS\System32\stdole2.tlbstdole F QyP.E .`M C:\WINDOWS\System32\FM20.DLLMSForms aa`10mG{r, 0C:\DOCUME~1\bushd2\LOCALS~1\Temp\VBE\MSForms.exd AaipL-[DR?C:\Program Files\Common Files\Microsoft Shared\Office10\MSO.DLLOffice 1YMain Module1k F=&}Bs3~ʘ,xsIaVZ> FDocument @FormsSpellCheck2 F F cladd87 F( F^ F@rU~}   Enter Personal InformationNormal.MyInfo.Main 1brU~| k__SRP_1[__SRP_2 ^T__SRP_3`o__SRP_4 brU $`anrU  41Y0`rU @nrU~| __SRP_5eB__SRP_6g__SRP_7rgThisDocumentt  A q *pt$ 4t <lptU):`NPPt$ 4t t5Pt$ t t/Lt$ 4t QL[HxtD"tx t tW'''$'D'd''''cP''$tx t Xt6P$dD$ xD*pt$ 4t <lpt5:`NPPc$t$ 4t t6P$0HDxDtLP$dD$krU $`nLz55#<=&}Bs3~ʘ F,xsIaVZ>x,xsIaVZ>=&}Bs3~ʘME(SLSS6"N0{00020906-0000-0000-C000-000000000046}(%H0(p % %pxH@8HdJ0$*\Rffff*044a7810b54xAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |GlobalSpacFalse dCreatablPredeclaIdTru BExposeTemplateDerivBustomizD2ID="{27FF8697-6AF0-47DD-B464-25945C31BCE1}" Document=ThisDocume_VBA_PROJECTCPROJECTPROJECTwmVCompObjjas  *\G{000204EF-0000-0000-C000-000000000046}#4.0#9#C:\Program Files\Common Files\Microsoft Shared\VBA\VBA6\VBE6.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.2#0#C:\Program Files\Microsoft Office\Office10\MSWORD.OLB#Microsoft Word 10.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINDOWS\System32\stdole2.tlb#OLE Automation*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\WINDOWS\system32\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{A0153031-6DFC-47FD-A17B-72A4FAA1D82C}#2.0#0#C:\DOCUME~1\bushd2\LOCALS~1\Temp\VBE\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M &*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.2#0#C:\Program Files\Common Files\Microsoft Shared\Office10\MSO.DLL#Microsoft Office 8.0 Object Library  HdJ05ThisDocument044a7810b5ThisDocument5 MyInfo184a644473 MyInfou'Module11=4a6449c3|Module18 X8Fx5yʽMN'eb=.ǂPF,@`HQe ~Guxc\e2 asCeachRfalse_IfbinSubthenTrue Wordk VBAWin16~Win32MacVBA6# TemplateProjectEstdole`MSFormsCOfficeu ThisDocument< _Evaluate MyInfo@(Main,iRet,pUserName\ UserTitleV9AreaCode UserPhoneYourExthLFaxACjYourFaxrN UserOffice0 UserAddressFUserCity UserStateUserZipDUserCOUserDIUserSEC4UserUN0UserWKR,BossNamef BossTitleH WordBasic BeginDialogFTextBoxQOKButton| CancelButton EndDialogmP dlgUserInfo2" CurValuesȤ UserDialogYourName;RGetPrivateProfileString$x YourTitleA# YourPhone YourOffice YourAddressYourCity YourStateYourZipYourCOYourDIYourSECvYourUNVYourWKRnDialogfSetPrivateProfileString=ExistingBookmark SetFormResultDocumentj Module1b formsspellm _B_var_subcheck2Formsspell(FormsSpellCheck2gzxo FormFieldActiveDocument\ProtectionType _B_var_ifPwdNoProtectionActiveS _B_var_Active Unprotect?Passowor.OptionsCheckGrammarWithSpelling _B_var_ForjL FormFields-|Range  NoProofing] CheckSpellingW AlwaysSuggest _B_var_Next'oProtectfPasswordnoresetgwdAllowOnlyFormFields! Passoword1l }6nt/&H00000000 Module=MyInfo Module=Module1 Name="TemplateProject" HelpContextID="0" VersionCompatible32="393222000" CMG="D9DB33C137C137C137C137" DPB="0406EEDB320733073307" GC="2F2DC53CDB4C074D074DF8" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=132, 132, 579, 561, MyInfo=88, 88, 535, 517, Module1=154, 154, 601, 583, Z ThisDocumentThisDocumentMyInfoMyInfoModule1Module1  FMicrosoft Word Document MSWordDocWord.Document.89q @  Bbjbj $.^".^"8Q8Q8Q8Q8QLQpQZ[[\dLQlbdeeeee.i4k l"l"l"l"l"l"l$mRpFl-8QkeekkFl8Q8Qeeslkkkk8Qe8Qe lkk lkk8Q8Q^Vtkeb pQp#jpQkkl l0lkpkpkLQLQ8Q8Q8Q8Qp8QkkkkkkkkkFlFlLQLQ$pQkLQLQpQ FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEc( P x     : ^      Hj(PxRQPOkNMLKJIHGFEDCBA@?>=<( * 8 : < P R T Z \ ^ ` t v                    "68FHJ^`b~qjhYq5U hYq5jhYq5UjPhYqUjhYqUjhYqUjRhYqUjhYqUj0hYqUjhYqUmHnHujzhYqUhYqjhYqUjhYqU,bfhjl$&(*>@NPRfhڶڶڶ}rjchYqUjhYqUjhYqUjUmHnHujU jUjhYqUjhYqUmHnHuj<hYqUjhYqUjhYqUhYqjhYq5UjhYq5UmHnHu,hvxz .0>@BVXfhj~jhYqUjhYqUjrhYqUjhYqUj6hYqUjhYqUmHnHujvhYqUUjhYqUj hYqUj,hYqUhYqjhYqU2@h*Lp ,Px@jihgfedcba`_^]\[ZYXWVUTSXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       (*,@BDHJLNbdflnpr   "$j^hYqUjhYqUj9hYqUjhYqUjhYqUjhYqUjhYqUmHnHujehYqUjhYqUj^hYqUjhYqUhYq3$(*,.BDFLNPRfhvxz.02<>BjhYqUj:hYqUj^hYqUjhYqUjjhYqUjhYqUjhYqUhYqjhYqUjhYqUmHnHu,@B/ =!"#$%#Enter your Bureau/Office/Unit name.DCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: Suite or Apartment Number, C/O)Address1D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)D ClientCity UppercaseEnter the Addressee's City. ClientStateD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. ClientZipD ClientZip UppercaseKEnter the Addressee's Zip Code (+4 if known) (Example: 48909 or 48909-7537)D CoAddress UppercaseaEnter the County's mail address (street address, PO Box, etc., where the mail will be delivered).D CoAreaCodeEnter the County's Area CodeDCoCity UppercaseEnter the County's City.D CoExtensiond8(OJQJ_HmH sH tH XOX CaseNumber1?d8(OJQJ_HmH sH tH XOX ClientCity1@d8(OJQJ_HmH sH tH ZOZ ClientState1Ad8(OJQJ_HmH sH tH ZO"Z ClientZip1BdtCJOJQJ_HmH sH tH VO2V CoAddress1Cd8(OJQJ_HmH sH tH XOBX CoAreaCode1 Dd`CJOJQJ_HmH sH tH PORP CoCity1Ed8(OJQJ_HmH sH tH ZObZ CoExtension1Fd8(OJQJ_HmH sH tH ^Or^ CoPhoneNumber1Gd8(OJQJ_HmH sH tH ROR CoState1Hd8(OJQJ_HmH sH tH ^O^ CoSuppaddress1Id8(OJQJ_HmH sH tH XOX CountyName1Jd8(OJQJ_HmH sH tH \O\ CountyNumber1 Kd`CJOJQJ_HmH sH tH ROR CoZip1LdtCJOJQJ_HmH sH tH NON Date11 Md`CJOJQJ_HmH sH tH TOT District2 Nd`CJOJQJ_HmH sH tH LOL FaxAC Od`CJOJQJ_HmH sH tH VOV FirstName1Pd8(OJQJ_HmH sH tH XOX FirstName21Qd8(OJQJ_HmH sH tH `O"` GranteeAddress1 Rd`CJOJQJ_HmH sH tH \O2\ GranteeCareof Sd`CJOJQJ_HmH sH tH XOBX GranteeCity Td`CJOJQJ_HmH sH tH `OR` GranteeClientID Ud`CJOJQJ_HmH sH tH dObd GranteeFirstName2 Vd`CJOJQJ_HmH sH tH bOrb GranteeLastName1Wd8(OJQJ_HmH sH tH ZOZ GranteeState Xd`CJOJQJ_HmH sH tH VOV GranteeZip Yd`CJOJQJ_HmH sH tH TOT LastName1Zd8(OJQJ_HmH sH tH VOV LastName21[d8(OJQJ_HmH sH tH ROR OtherID1\d8(OJQJ_HmH sH tH ROR Section2 ]d`CJOJQJ_HmH sH tH ^O^ SuperAreaCode1 ^d`CJOJQJ_HmH sH tH `O` SuperExtension1_d8(OJQJ_HmH sH tH dOd SuperPhoneNumber1`d8(OJQJ_HmH sH tH `O` SupervisorName1ad8(OJQJ_HmH sH tH LO"L Unit2 bd`CJOJQJ_HmH sH tH PO2P Worker2 cd`CJOJQJ_HmH sH tH `OB` WorkerAreaCode1 dd`CJOJQJ_HmH sH tH bORb WorkerExtension1ed8(OJQJ_HmH sH tH TObT WorkerFax fd`CJOJQJ_HmH sH tH XOrX WorkerName1gd8(OJQJ_HmH sH tH \O\ WorkerName2hd8(5OJQJ_HmH sH tH ZOZ WorkerPhone1id8(OJQJ_HmH sH tH ^O^ WorkerTitle1jd8(5OJQJ_HmH sH tH LOL Emailkd8(OJQJ_HmH sH tH $@0 0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumber CoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictEmail/FaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherID Section! SuperAreaCode"SuperExtension#SuperPhoneNumber$SupervisorName%Unit&Worker'WorkerAreaCode(WorkerExtension) WorkerFax* WorkerName+ WorkerName2, WorkerPhone- WorkerTitle.0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstName1GranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitleUser Input 10pt(<Pdu$5I]n  4EYm(<Pdx( J" '/?58e?E6d< @ZGJOpVr[p^_Pazc( bh$B$(,38@GMQV]fpx   : 8 P j L\~4dNFt ~!V !!$$*%g&''I((o),&-V--.02423M442566677.88J9z9`::Q<<=J>> ??^AAB,C\CnDDEFHFFF&G667Z89:J<z<==l>*?Z?$@@@4CDFDxFFlGH>H2IbIJJJKLHMNJNROO PnPPR4R S\SVVVWXYZZZX[[\]^^_p__0`j``*axaabb0cc@B%')*+-./01245679:;<=>?ABCDEFHIJKLNOPRSTUWXYZ[\^_`abcdeghijklmnoqrstuvwyz{|}~ B&  &(4:<HNP\bdpsu"$035AGIU[]ilnz   ,24@CEQWYekmy"&(4:<HNP\bdpvxFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipdate1DistrictEmailFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitle)=Qev%6J^o !5FZn)=Qey  !"#$%&'()*+,-./';Oct#4H\m 3DXl';OcwYq@ CHCC(` ``UnknownG: Times New Roman5Symbol3& : Arial?5 z Courier New"h0@?Yq