%PDF-1.6
%
1 0 obj
<>
endobj
2 0 obj
<>
endobj
3 0 obj
<>
endobj
4 0 obj
<>
endobj
5 0 obj
<>
endobj
6 0 obj
<>
endobj
7 0 obj
<>
endobj
8 0 obj
<>
endobj
9 0 obj
<>
endobj
10 0 obj
<>
endobj
11 0 obj
<>
endobj
12 0 obj
<>
endobj
13 0 obj
<>stream
2011-02-28T10:49:41-05:00
Acrobat PDFMaker 8.1 for Word
2022-12-05T14:20:49-05:00
2022-12-05T14:20:49-05:00
Acrobat Distiller 8.2.6 (Windows)
application/pdf
David Lopez
Division Use Only — DLN Stamp
uuid:d47d4095-236c-4d38-a29e-843906fb8e8d
uuid:afe4872c-f2b0-2b91-5cd3-784e89956684
Department of Treasury
1
B
endstream
endobj
14 0 obj
<>
endobj
16 0 obj
<>
endobj
17 0 obj
<>/Font<>>>/Fields[20 0 R 21 0 R 23 0 R 24 0 R 1 0 R 2 0 R 33 0 R 3 0 R 4 0 R 5 0 R 45 0 R 46 0 R 47 0 R]/SigFlags 2>>
endobj
18 0 obj
<>
endobj
19 0 obj
[20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R]
endobj
20 0 obj
<>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/Ff 8388608/MK<<>>/P 18 0 R/Rect[424.828 681.481 560.901 700.007]/Subtype/Widget/T(Text1)/Type/Annot>>
endobj
21 0 obj
<>/P 18 0 R/Rect[76.6608 523.049 317.864 537.464]/Subtype/Widget/T(Text2)/Type/Annot>>
endobj
22 0 obj
<>/P 18 0 R/Parent 1 0 R/Rect[320.697 522.41 560.901 537.742]/Subtype/Widget/T(0)/Type/Annot>>
endobj
23 0 obj
<>/MaxLen 15/P 18 0 R/Rect[77.2996 497.495 196.124 510.911]/Subtype/Widget/T(Text4)/Type/Annot>>
endobj
24 0 obj
<>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/Ff 8388608/MK<<>>/P 18 0 R/Rect[198.04 497.217 318.142 511.188]/Subtype/Widget/T(Text5)/Type/Annot>>
endobj
25 0 obj
<>/P 18 0 R/Parent 1 0 R/Rect[320.697 496.8 560.901 511.132]/Subtype/Widget/T(1)/Type/Annot>>
endobj
26 0 obj
<>/N<>>>/AS/Off/BS<>/F 4/FT/Btn/MK<>/P 18 0 R/Parent 2 0 R/Rect[80.4938 473.219 91.3541 483.44]/Subtype/Widget/T(0)/Type/Annot>>
endobj
27 0 obj
<>/Subtype/Form/Type/XObject>>stream
Hl
0EL
PN^EO&
B)ZVKad;Ͽ>˷M