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EXHIBIT B -12 <br />200109053 <br />SELF EMPLOYED INCOME VERIFICATION <br />I hereby attach copies of my individual federal and state income tax returns for the immediate preceding <br />three calendar years for which such income tax returns could have been filed (or, if not filed, were not <br />required to be filed) and certify that the information shown in such income tax returns is true and <br />complete to the best of my knowledge. <br />Signature <br />01- 351904.01 <br />Date <br />