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STATEMENT OF <br />ELECTED/APPOINTED OFFICER <br />I, -DA,uNK rAW do solemnly swear (or affirm) that I have not <br />directly or indirectly paid, offered, promised to pay, contributed, or promised to <br />contribute any money or thing of value, or promised any public office or employment <br />for the giving or withholding of a vote at the election at which I was elected or as a <br />reward to secure my appointment or confirmation, whichever the case may be, so help <br />me, God. <br />UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING <br />STATEMENT AND THAT THE FACTS STATED THEREINARE TRUE. <br />Date Signature o oer <br />Ccw�orwL QrNBwiaPNG BOW OF <br />Position to Which Elected/Appointed <br />Form No. 2W1 <br />