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sbrw ~~ BTANOARD FORM 1 ~~~~ <br />UNiF'ORM COMMERCIAL. CODE <br />STATEAYlNTS OF CaNT~{IATIOIt, PARTtAt RELEASE, A53i8NAYNT, ETC. ' <br />Itds AAR77tiNiF is pr+s.nha M a pOnp ofRnr (er dia4 PuraWN ro th. Untfonn Cowssxctd Cad.: 3. MNOaM dea tff oay1: - - <br />t. D.Mos;si tlmt Mann RrsH an+Y aadr.sshs! i 2. S.surui PaMfi.s) and oddrass(uy ~____-_l For Rtirq- OAw 10as.. T ss. am3 FOtnp Ollk.t <br />HARRiNGTO?l, Jahn A., Douglas B The Prudential Insurance <br />~iTZPATRII;K, Sue Ann ! Company of America ' 80'-t~e~~1~J'~ ~- <br />8e~x 330:1 P.Q. Sex 1°f43` ~ <br />6ratrci Island, Nebraska 66801 ~ Minneapvli.s,-Minnesata.55#491 <br />">. ~ ~. t~78-00723 ~ <br />a> rw..tala.,N nF.. FF ` - ~..~"F~Frc. Ne..- $77. _ ... .. . <br />Req. of ~ 1,.~'= T i <br />Fa.a.an..C4... C1er~,~Fia.~,,,Co-.. aa.} ...November. 3.1978~p; ~ <br />~..; ~`j~-rM ~~./~.0 s1aNe.at WM~~in Ma esrpeing~ D661ar ana S.euna Fanp. bwinp nta nawMr shown a6aw. is sNN .~MMa. <br />(s ~'J T~aM. s.ss~a F~wh no loawr doi.a a sdiar7h inrs.u w:dw N:. nnaadn4.,eaa.ant b.ari~.ea nua:6w .maa o4e.., <br />T.--:: j~ ~°R' . ~ifa :~ pa~+ .pane u.q~r`t#. ;eem~ans .ran...ne n.e<tnB at. nan~w. rno..a ab.+. a nn arewnr d..uie.d-tn u.w to:eew <br />tn.etrare.a ti'~n vs.i~,.~a.t,~a.. ana aaank ate.... in ie.~ lo. <br />h.sany yr+,wiYas sinwn abo.. is ea.ad.d os sN foah in IM 10. <br />IQ~ ~.^~ ~u tM a>tlafkM dncdb.d in lain 10 hem IM Mooc{~ staangnt b.oaap Al. nuss6w .sewn obew. - <br />tiRD~maAEk1&~^s1~uYi71~~Y •~'i~ie-%z .'~"RC~~wiys r+nntwrotaaut~enasn«nweF«aaa.---:°-- <br />~~-??r~~'r€~x ~ # -> Prudent~al_ Insurance, C~npa€+;~ af-liner;e~-----_ <br />_ .._..~... .- .... .. -. - Reg: of Dee.., - <br />at O.tfFanis) teuassaev only iF lanai. applimtsa4 .. .... Signah+ ) IF s.earad Perq(ins! <br />t» PI~,F oerw ~Cevr Michael J. Petersen. Attorney <br />I i <br />it <br />I i <br />+ ~ _~ <br /> <br />