Case: 1:20-cv-06006 Document #: 1-13 Filed: 10/08/20 Page 1 of 1 PagelD #:96

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Dated this day of VAN 20' #

Prepared by: Don ao er Klee he

* Attorney's Name:

Address: ( (AD SO, Aon (p~\"c Coo
City: CUS Cees State: _|C
Phone: Sle Ge \ ¢ “EE Gip Code: COG o|

Fax: “He Cr\ O47 O4
ARDC: CaO \ 7 | tar

171-94 (Rev. 1047)

 

 

 

 

 

 

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