13 MARCH ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
_ Board of Building Regulations and Standards CITY OF
1
S
Massachusetts State Building Code, 780 CMR ALEMRevised Mar 2011
Building Permit Application To Construct, Repair, Renovate nolish a
One- or Tivo-Family Dwelling
This Section For Official Us my
Building Permit Number: Date Appl d:
UXLLlc L�kf?!A
wilding Official (Print Name) Sign to Date
SECTION 1: SITE INFOIMAIAON
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
G R N� = 4fi
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information:" - - 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(ft)
1.5 Building Setbacks(ft)
` Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.I.,c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone?Check ifyes❑ Municipal ElOn site disposal system El
SECTION 2: PROPERTY OWNERSHIP'
2.1 caner of Record:
Name(Print) �� Ci y.State.ZIP
No. and Street Telepho e Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Codstruction ❑TE.xrsting Building❑ Owner-Occupied ❑ 1 Repairs(s)xf Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': m O
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
r (Labor and Materials)
I. Building $ sp- I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
. Plumbing $ 2. Other Fees:
4
. Mechanical (HVAC) $ List: �
5. Mechanical (Fire
Suppression) $ Total All Fees: $
6. Total Project Cost: $ Ob Check No. Check Amount: Cash Amount:
❑ Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
elrow �gl -- /Z
License Number Fa iratio ate
Name of CSL Holder
,Iubv vh List CSL Type(see below)
Noo. and Sweet 'type Description
U Unrestricted(Buildings up to 35.000 cu. ft.)
Jr tJ R 12estricted 1&2 Family Dwelling
ih own. te.ZIP M Mason
RC Roofing Covering
WS Window and Siding
SF Solid Fact Burning Appliances
I Insulation
'Iele hone Email address D Demolition
5.2 Registered Home Improvement_Contractor(HIC)
t a•�� � /�/���H IC Registration Number F. pir on Date
HIC Coin aname or HICdRevsflan�,�v at�y�
/36 / , .-e-)l e/1 ��` /Dd
�fj/? �'T� E ail trcss
�cro�
Crt /Town,State,ZlP 'fele hone ��
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6))
Workers'Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property, hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
-Om Y✓at Q
Print Owners Name(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby atte t unde the pains and penalties of perjury that all of the infortttation
contained in this application is tru a urat t Ab�of my knowledge and understanding.
t
Print Owner's m Authorized Agent's Ic r Si Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass eov/oca Information on the Construction Supervisor License can be found at www.ntass.gov,Aps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics, decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
. Department of Industrial Accidents
W Office of Investigations
600 Washington Street
Boston, MA 02111
www mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information �/ Please Print Legibly
Name (Business/Organiz tion/Indiivtidual): Vl�enE Maw
Address: I Auburn I.hA
City/State/Zip: U OI 06 Phone#: 7d'�"233 o9ao
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. El New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
These sub-contractors have
ship and have no employees 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.# 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Pirs-' FinAncaI T-- surome Comrp q
Policy#or Self-ins. Lic.#: N fi�Don6 D,9,9L Expiration Date:
Job Site Address: t3 t Y v�L'vll � City/State/Zip:Sq,(aon, W&-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: �� Date:
Phone#: M` 233-0100
Offwial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CERTIFICATE OF LIABILITY INSURANCE GATE(MM DNYVYYI
Da/12/2012
THIS CERTIFICATE IS 153UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIONTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IN3URER(8), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER !.
IMPORMT; If the Cert) Cate h410erto
M en D AL IN UR O; the p011Cyt109) MWt Bnd01)ed. U6 I 41VED, fwJOGt W
the terns and conditona of the policy, Certain policies may require an endorsement A statement on this carti0cata does not confer Hgtttf ec the
certificate holder In Ileu of such endomement(a).
PRODUMER FiALPB J. QUINN
NAME:
RA1.PH J. QUINNINSIIRANCE AGENCY �781-395-8400 781-395-8083 41C Ne Fat:
15 kDaN STREET ADOReff RJQOINNINSORANCEBAOL.COtQ
M6DSORD, MA 02155"PRaDUCFA _.._-_—.__—___........ ._...__._._.__._.._.....-..
METOMERID W.
_.. PI9IRIFJt(BIAFFOROING COVERAGE NAICB
maURm NTNDOTP CHOICES INC. INauAER AFIRST SINANCIAL INSURANCE COMPANY ....
ONE AtTBtHtN COURT
metAIERBPLYtdOUTH ROCK ASSURANCE CORP.
-
INSURERC
SAUGUS, MA 01906 IrmoREao: —
MMUREA E w
MBmiER F: --
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT. WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONOIJICNS OF SUCR POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
LTR TYPE OF NSUMHCE VJAR M%) POLICYNUMaER ...
A I GBNERAt WBIUTV PIMNDMYY'YI Ienanow YI UMTB
491FOO6099 04/27/11 04/27/12 Fncn OCCIJMRENCE s1,000,000
K COMMERCIAL GENERAL LIABILITY -TTAiOWE TO'RERIEO_._ __.._ ._.__........._.._.. _
04/27/12 04/27/13 PREMISESIFAvtcwtam.l s 100,000
CIAIMSMADE CI OCCUR
MEO EXP(Af Ws WM,) _ 9 5,000
PER$O AADVIIUVRY 41,000,000
OEN'L AGGREGATE LIMIT A IER PER: OENERALAGCREDATE s2,000,006
!POLICY PRO'
PRGOUcis.coMW(W AOe i2,000,000
JECT LOC ^„
AUTOMgteE LJABILDY 3
B -- PRA00001163343 01/19/12 01/19/13 COMMNED SINGLE LINm
XANY AUTO (Er erzitlenry f .
ALL IYANEDAUTOS BODILYINJURYIPorp.nnn) f 100,000
SCNEOULEDAUTOS BODILY INJURY(PercgdrP, a 300,000
K HIMBDAUTOe PROPERTVOAMACE— r SDO,OOO(Pw vc�e.,U
K NONONNEOAWOS 491FOO6099 04/27/11 04/27/12
Is 11000,000
UMBRELU UAe OCCUR - 04/27/12 04/27/13 AGGREGATE a 2,000,000
1 EXCESS LIAR EACH O(XAIRMENCE a
_ CWMauADE
DEDUCTIBLE AGGREGATE f
RETENTg f f
!i vJORKERa CDMPE MAMw f
AND EMPLOYER,'IJnaR.RY _
ANY PROPRIETORmAnTNEIVD(EcunyE YIN TORY UUMS ER
GPFICERMEMBER EUCLVOEM ILJI NIA
IMr _EL.EACH ACC
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DEZRIPTION OF OrPERATION,p N, EL NSEASE-EA EMPLOYEE I i
E.L.DMEA,POLICY UMR 1
DEBCRIPTgN OP OPNATroNB l LOCATroNe I YENCLEB IAroaB ACORp 101,AMRbnd RMIIrHa 3dNEVM,X mon rpAa w+tpunel
CERTIFICATE HOLDER
CITY OF GLOUCESTER CANCELLATION
3 POND ROAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
GLOUCESTSR, EBA 01930 THE EXPIRATION DATE T"ER IOF, NOTICE Wa.L BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
! AUTHORIZED REPRESENTATryF
AF
ACORD 25(2008109) The ACORD name an ® (, „ CO N. it rig to reeMI
�/i n / d IogD aro registered marks o1 ACORp 1.
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9� eozai;eaa eusOffice of Consumer Affairs and ness Regulation
]0 Park Plaza - Suite 5170
Boston, Massa*setts 02116
Home Improvement Q trga�tor Registration
Registration: 163,05
Type: Private Corporation
WINDOW CHOICES INC <' Expiration: 5/11J2013 7# 211575
VINCENT KILROW -- —
I AUBURN CT. - -- - - --- - -
SAUGUS, MA 01906
Update Address and return card. Mark reason for change.
oPS-CAt O 50u-04N Gr¢)215 `_; Address ri Renewal �_ Employment — Lost Card
6d� _
Ofnee�fYAorumer airs ems$ 'ness"IFeR aut noa License or registration valid for individul use only
HOME IMPROVE
MENT CONTRACTOR before the espi ration date. 1f found return to:
Registration: 163105 Type: Office of Consumer Affairs and Business Regulation
Expiration 5S11£d013
y1v
Private Corporation 10 Park Plana-Suite 5170
Boston,MA 02116
VINCENT KILROW
1 AUBURN CT -
`� -
SAUGUS, MA Of 906 .. wry
Uadersecretary Not valid without signature
1, ,.. .... A;'rn,
13naid of Buildin•- Rreu Lui.in. :intl
License: CS SL 99170
Restricted to: RF,WS
VINCENT KILROW
1 AUBURN COURT
SAUGUS, MA 01906
E:p;ration: 12/27/2012
. t .nun...i..ro-r 99170
L _—
GT7i¢ �nomrmwuu�eall7e aa�ac7ie�ae!!a
Z+�**,,�\ Office of Consumer Affairs&Business Regulation
OME IMPROVEMENT CONTRACTOR
Registration; 146666 Type
Po' e
ExpiraHott; r1D116f24013 Supplement '
LOWE'S HOMER C€ 1 ERt61i(CL
RICHARD CHALONE:. '
136 TURNPIKE RD.StiwTE -00`
SOUTH B0R0UGH,'MA 01772 Undersecretary -
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.� CONTRACT#1w,,1���SP
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MASSACHUSETTS EXTERIOR SOLUTIONS JNSTALLED;SALES CONTRACT` - ,
FIN-STALLED SALES SPECIALIST f NUMBER CUSTOMERS_ y ' -
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f37 Jr 5d1 Ixa x)✓1
STORE NO STREET ADDRESS f( ` STREET ADDRESS f
'r f2 ?i\\FY_fr X7 r—
GIN STATE ZIP s CITY _ - STATE
TELEPHONE } TELEPHONE
Orv7 Fry t� FOE NE56 OO 8 HME 358CENTERS,INC S MA HIC NO.: 148688 r= + CnSH snrv8y LCC ,� CHnRGE �'' �" 3y
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This is only a quote for the merchandise and services printed below This becomes an agreement upon payment Upon payment ttie entire agreemenp-inGudi the speGfcatly mmpleteil pages of this
'document,the Terms and Conditions included with this document and any other addenda and attachments hereto shall be referred to herein as III,,s Contract s. ts+.�x- this
i
'-PLEASE READ ALL TERMS AND CONDITIONS ON THEREVERSE SIDE OF.THIS PAGE AND FOLLOWING PAGES BEFORESIGNING n`iW r `r r.'✓fi .* .
- INSTALLATION STREET ADDRESS ,JCITY f STATE ZIP r
I C:.,at;;, ,>s rr.a°:, .#r• /Y- ,',,c/saran ;�i .�� c�C?'rrrl .S
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�*appl2oable
ntract Total
Are permits required for this installation?: KI Yes [ �JN4o: tax included a`
�c ozlo 27
i NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
i
from renovation activity to be performed in Customer's dwelling unit.
PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this
Contract„and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.. -
Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such r
photographs for any lawful purpose, including,but not limited to, marketing, advertising, publicity, illustration, training and Web content. By initialing
here,Customer agrees to the foregoing. [Customer to initial to the.left].
I Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be
[fille in date].Estimated completion date is �7/.Ss's;�f2, [fill in date].
1 Said estimated substantial completion date is not of the essence. A statement of any contingencies that would materially change said estimated substantial
completion date is as follows:
i (if applicable,inserta statment of such contingencies), II
1 IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full.
j COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: -
{t']Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: -
`(1)Deposit $ -to be paid upon siging contract.Deposit should be 1/3 the total contract price;and
(2)Payment of$ - to be paid anytime after this Contract is signed and before commencement of installation, IM/e authorize Lowe's
l to do one of the following(check appropriate box below):
[ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or[ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and
(3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A
LOWE'S AND OWNER.HEREBY MUTUALLYAGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT
�, .. LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED.BY THE SECRETARY OF.THE EXEGUT-,,.
{ IVE OFFICE OF CONSUMER AFFAIRS AND BUISNESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCMARBITRATION1
! AS PROVIDED-IN M G.C..c.1,42A. p
} By: t'. ,....�„• ±yf pr'r'r Date: X i F, d
L
( l
d
J
_Otl'- f..✓
Contract Total e=
Are permits required for this installation?: EEr]Yes [ ] No *applicable tax included
NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
from renovation activity to be performed in Customer's dwelling unit.
PHOT:RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this
Contra irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.
Custothorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such
photogfor any lawful purpose, including,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing
here, er agrees to the foregoing. [Customer to initial to the leftl.
Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be
[fille in date].Estimated completion date is R117.,. [fill in date].
Said estimated substantial completion date is not of the essence. A statement of any contingencies that would materially change said estimated substantial
completion date is as follows:
(if applicable,inserta statment of such contingencies).
IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. -
COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00:
]1']Customer to Pay in Full; OR [ ]Customer to use the following payment schedule:
'(1)Deposit $ to be paid upon siging contract.Deposit should be 1/3 the total contract price;and
(2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's..
to do one of the following(check appropriate box below): -
( ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and -
(3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A
LOWE'S AND OWNER HEREBY MUTUALLYAGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT;THAT.
LOWE'S MAY.SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- R
IVE OFFICE OF CONSUMED AFFAIRS AND BUISNESS REGULATIONS AND THE OWNER SILL-BE REQUIRED TO SUBKAITTO SUCH'ARBITRATION°e +'.
AS PROVIDED-IN M G:L``c.142A f /
By: Date: Z'r
Lgwe's'Home Centers fM f f 1
q ,� z .�^^^ Date: �i�ff .
Ov-finer Signature
_ THESIGIQATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED
. BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAYBE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE�THE
SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND
CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.
BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE
TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS.
CONTRACT. YOU ARE ENTITLED TO A COPY OFTHIS CONTRACT AT THE TIME OF SIGNATURE'.
{ WITNESS OUR HAND(S)ANLZSEAL�S)BELOW THIS Gr<' DAY OF ad&)/
Lowe's-Home..�e t rs, Inc.'
Specialist or Abcve --+ 117 Co-owner or Witness
Customer acknowledges recelipt of a true copy of this cont7act-which was completely filled in prior to Customer's execution hereof.You,the buyer,may
cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation
{ form for an explanation of this right. -
®2004 by Le a Lowe' and the gable design
3k90981 (Rev. 12/10)
i FIL.£(.ESPY are registered trademarks of LF CorparaHon..
I -