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Get FDIC 6800/03 2005-2024

(a) of the Securities Exchange Act of 1934 OMB NUMBER: 3064-0030 EXPIRES: 07/31/2013 Estimated average burden hours per response ...1.0 (PLEASE PRINT OR TYPE ALL RESPONSES) 1. Name of Reporting Person (Last, First, Middle)* 2. Date of Event Requiring Statement (Month/Day/Year) 4. Issuer Name and Ticker or Trading Symbol Street Address 3. IRS Identification Number of 5. Relationship of Reporting Person to Issuer (Check all Reporting Person, if an Entity applicable) (Voluntary) Director 10% .

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