1)
|
Title
of each class of securities to which transaction
applies:
|
2)
|
Aggregate
number of securities to which transaction
applies:
|
3)
|
Per
unit price or other underlying value of transaction computed pursuant to
Exchange Act Rule 0-11 (Set forth the amount on which the filing fee is
calculated and state how it was
determined):
|
4)
|
Proposed
maximum aggregate value of
transaction:
|
5)
|
Total
fee paid:
|
1)
|
Amount
Previously Paid:
|
2)
|
Form,
Schedule or Registration Statement
No.:
|
3)
|
Filing
Party:
|
4)
|
Date
Filed:
|
|
(1)
|
To
elect three (3) Directors to three-year terms of
office;
|
|
(2)
|
To
appoint independent accountants to audit the financial statements of the
Company for the year 2008; and
|
|
(3)
|
To
transact such other business as may properly come before the
meeting.
|
|
By
order of the Board of Directors,
|
|
BRUCE
C. McINTOSH
|
|
Secretary
|
Director
|
Full
Shares
|
Percent
of
|
|||||
or
Officer
|
Owned
|
Total
Shares
|
|||||
Name
|
Age
|
Principal
Occupation During Last Five Years
|
Since
|
Beneficially
|
Outstanding
|
||
(1)
|
(2)
|
||||||
John
L. Finlayson
|
67
|
Vice
President
|
9/2/1993
|
17,678
|
0.15
|
||
Susquehanna
Real Estate, LP
|
|||||||
May
2006 to date
|
|||||||
Vice
President-Finance and Administration
|
|||||||
Susquehanna
Pfaltzgraff Co.,
|
|||||||
Radio
Stations, Cable TV,
|
|||||||
August
1978 to May 2006
|
|||||||
Thomas
C. Norris*
|
69
|
Retired,
Chairman of the Board, Glatfelter,
|
6/26/2000
|
17,427
|
(3)
|
0.15
|
|
Paper
Manufacturer, May 2000 to date
|
|||||||
Ernest
J. Waters
|
58
|
York
Area Manager, Met-Ed, a First Energy
|
9/25/2007
|
100
|
0.00
|
||
Company,
Electric Utility
|
|||||||
March
1998 to date
|
|||||||
TO
CONTINUE FOR TERMS EXPIRING IN 2009
|
|||||||
Director
|
Full
Shares
|
Percent
of
|
|||||
or
Officer
|
Owned
|
Total
Shares
|
|||||
Name
|
Age
|
Principal
Occupation During Last Five Years
|
Since
|
Beneficially
|
Outstanding
|
||
(1)
|
(2)
|
||||||
George
Hay Kain, III
|
59
|
Substitute
School Teacher, April 2007 to date
|
8/25/1986
|
33,956
|
(4)
|
0.30
|
|
Consultant,
December 2004 to April 2007
|
|||||||
Michael
W. Gang, Esq.*
|
57
|
Attorney,
Post & Schell PC, Counselors at
|
1/22/1996
|
8,454
|
0.07
|
||
Law,
October 2005 to date
|
|||||||
Post
& Schell PC is counsel to the
|
|||||||
Company
|
|||||||
Partner/Attorney,
Morgan, Lewis & Bockius,
|
|||||||
Counselors
at law, October 1984 to
|
|||||||
October
2005
|
|||||||
George
W. Hodges
|
57
|
Chairman,
The Wolf Organization, Inc.
|
6/26/2000
|
6,129
|
(5)
|
0.05
|
|
February
2008 to date
|
|||||||
Office
of the President, The Wolf
|
|||||||
Organization,
Inc., Distributor of Building
|
|||||||
Products,
January 1986 to February 2008
|
|||||||
Jeffrey
R. Hines, P.E.*
|
46
|
President
and Chief Executive Officer
|
1/28/2008
|
27,359
|
(6)
|
0.24
|
|
March
2008 to date
|
|||||||
Chief
Operating Officer and Secretary
|
|||||||
The
York Water Company, January 2007
|
|||||||
to
March 2008
|
|||||||
Vice
President-Engineering and Secretary
|
|||||||
The
York Water Company, January 2003
|
|||||||
to
December 2006
|
|||||||
Director
|
Full
Shares
|
Percent
of
|
||||||||
or
Officer
|
Owned
|
Total
Shares
|
||||||||
Name
|
Age
|
Principal
Occupation During Last Five Years
|
Since
|
Beneficially
|
Outstanding
|
|||||
(1)
|
(2)
|
|||||||||
William
T. Morris, P.E.*
|
70
|
Chairman
of the Board, The York Water
|
4/19/1978
|
33,086
|
(7)
|
0.29
|
||||
Company,
November 2001 to date
|
||||||||||
Irvin
S. Naylor*
|
72
|
Vice
Chairman of the Board, The York Water
|
10/31/1960
|
87,296
|
0.77
|
|||||
Company,
May 2000 to date
|
||||||||||
President/Owner,
Snow Time, Inc., Owns and
|
||||||||||
operates
Ski Areas, June 1964 to date
|
||||||||||
Jeffrey
S. Osman*
|
65
|
Retired,
President and Chief Executive Officer
|
5/1/1995
|
17,996
|
(8)
|
0.16
|
||||
The
York Water Company, January 2003
|
||||||||||
to
March 2008
|
||||||||||
EXECUTIVE
OFFICERS
|
||||||||||
Kathleen
M. Miller
|
45
|
Chief
Financial Officer and Treasurer, The
|
1/1/2003
|
3,295
|
0.03
|
|||||
York
Water Company, January 2003
|
||||||||||
to
date
|
||||||||||
Duane
R. Close
|
62
|
Vice
President-Operations, The York Water
|
5/1/1995
|
11,087
|
(9)
|
0.10
|
||||
Company,
May 1995 to date
|
||||||||||
Bruce
C. McIntosh
|
55
|
Vice
President-Human Resources and
|
5/4/1998
|
2,298
|
0.02
|
|||||
Secretary,
The York Water Company,
|
||||||||||
March
2008 to date
|
||||||||||
Vice
President-Human Resources, The York
|
||||||||||
Water
Company, May 1998 to March
|
||||||||||
2008
|
||||||||||
Vernon
L. Bracey
|
46
|
Vice
President-Customer Service
|
3/1/2003
|
190
|
(10)
|
0.00
|
||||
The
York Water Company
|
||||||||||
March
2003 to date
|
||||||||||
All
Directors and Executive Officers as a group
|
266,351
|
(11)
|
2.36
|
(1)
|
Except
as indicated in the footnotes below, Directors possessed sole voting power
and sole investment power with respect to all shares set forth in this
column.
|
(2)
|
The
percentage for each individual or group is based on shares outstanding as
of February 29, 2008.
|
(3)
|
Includes
7,371 shares held by Mr. Norris' wife, for which Mr. Norris disclaims
beneficial ownership.
|
(4)
|
Includes
3,876 shares held by the estate of Mr. Kain's wife for which Mr. Kain
disclaims beneficial ownership. Also includes 15,059 shares
held by the estate of Mr. Kain's grandfather, for which he is one of three
co-trustees and shares voting power and investment
power. Shares are held in a brokerage account under terms that
require them to be pledged as a security for margin loans into which Mr.
Kain enters.
|
(5)
|
Includes
4,500 shares held by Mr. Hodges' wife, for which Mr. Hodges disclaims
beneficial ownership.
|
(6)
|
Includes
1,993 shares held by Mr. Hines’ wife, for which Mr. Hines disclaims
beneficial ownership.
|
(7)
|
Includes
shares owned jointly with Mr. Morris' wife, for which he shares voting and
investment power.
|
(8)
|
Includes
shares owned jointly with Karen E. Knuepfer, for which he shares voting
and investment power. Shares are held in a brokerage account
under terms that require them to be pledged as a security for margin loans
into which Mr. Osman enters.
|
(9)
|
Includes
259 shares held by Mr. Close's wife for which Mr. Close disclaims
beneficial ownership.
|
(10)
|
Includes
16 shares held by Mr. Bracey’s step-son for which Mr. Bracey disclaims
beneficial ownership.
|
(11)
|
Includes
shares owned by family members, and certain other shares, as to which some
Directors and Officers disclaim any beneficial ownership and which are
further disclosed in the notes above.
|
Ernest
J. Waters
|
George
W. Hodges
|
John
L. Finlayson
|
George
Hay Kain III
|
Michael
W. Gang, Esq.
|
Thomas
C. Norris
|
Publicly
Held Companies
Other
Than
|
||
Board Members
|
The York Water Company
|
|
Mr.
George W. Hodges
|
Fulton
Financial Corp.
|
Name
|
Title
|
Jeffrey
S. Osman
|
President,
Chief Executive Officer and Director
|
Kathleen
M. Miller
|
Chief
Financial Officer
|
Jeffrey
R. Hines
|
Chief
Operating Officer
|
Duane
R. Close
|
Vice
President-Operations
|
Bruce
C. McIntosh
|
Vice
President-Human Resources
|
Mr.
Osman
|
$1,389
|
Ms.
Miller
|
1,394
|
Mr.
Hines
|
1,444
|
Mr.
Close
|
1,235
|
Mr.
McIntosh
|
1,754
|
THE
COMPENSATION COMMITTEE
|
|
George
W. Hodges
John
L. Finlayson
|
George
Hay Kain III
Thomas
C. Norris
|
Change
in
|
||||||||||
Pension
Value
|
||||||||||
&
Nonqualified
|
||||||||||
Non-Equity
|
Deferred
|
|||||||||
Name
and
|
Incentive
Plan
|
Compensation
|
All
Other
|
|||||||
Principal Position
|
Year
|
Salary ($)
|
Compensation ($)
|
Earnings ($)
|
Compensation ($)
|
Total ($)
|
||||
Jeffrey
S. Osman
|
||||||||||
President,
Chief
|
||||||||||
Executive
Officer
|
||||||||||
and
Director
|
2007
|
286,953
|
14,348
|
116,003
|
1,772
|
419,076
|
||||
2006
|
269,083
|
13,714
|
178,177
|
1,950
|
462,924
|
|||||
Kathleen
M. Miller
|
||||||||||
Chief
Financial
|
||||||||||
Officer
|
2007
|
103,232
|
5,162
|
4,637
|
2,429
|
115,460
|
||||
2006
|
96,968
|
4,925
|
8,307
|
3,223
|
113,426
|
|||||
Jeffrey
R. Hines
|
||||||||||
Chief
Operating
|
||||||||||
Officer
|
2007
|
146,914
|
7,415
|
463
|
2,240
|
157,032
|
||||
2006
|
124,450
|
6,314
|
20,711
|
1,950
|
153,425
|
|||||
Duane
R. Close
|
||||||||||
Vice
President-
|
||||||||||
Operations
|
2007
|
126,440
|
6,322
|
37,105
|
2,240
|
172,107
|
||||
2006
|
119,305
|
6,053
|
65,456
|
1,950
|
192,764
|
|||||
Bruce
C. McIntosh
|
||||||||||
Vice
President-
|
||||||||||
Human
Resources
|
2007
|
99,412
|
4,971
|
9,080
|
2,240
|
115,703
|
||||
2006
|
96,022
|
4,826
|
20,077
|
1,950
|
122,875
|
Name and Principal Position
|
Estimated
Possible Payouts Under
Non-Equity
Incentive
Plan Awards Target ($)
|
|
Jeffrey
S. Osman
President,
Chief Executive Officer and Director
|
14,348
|
|
Kathleen
M. Miller
Chief
Financial Officer
|
5,162
|
|
Jeffrey
R. Hines
Chief
Operating Officer
|
7,415
|
|
Duane
R. Close
Vice
President-Operations
|
6,322
|
|
Bruce
C. McIntosh
Vice
President-Human Resources
|
4,971
|
Name
and
Principal
Position
|
Plan
Name
|
Years
of
Credited
Service
|
Present
Value
of Accumulated Benefit
($)
|
|
Jeffrey
S. Osman
President,
Chief Executive Officer
and
Director
|
General
and Administrative Pension Plan
|
24
|
759,803
|
|
Jeffrey
S. Osman
President,
Chief Executive Officer
and
Director
|
Supplemental
Executive Retirement Plan
|
24
|
310,232
|
|
Kathleen
M. Miller
Chief
Financial Officer
|
General
and Administrative Pension Plan
|
11
|
49,576
|
|
Kathleen
M. Miller
Chief
Financial Officer
|
Supplemental
Executive Retirement Plan
|
4
|
14,956
|
|
Jeffrey
R. Hines
Chief
Operating Officer
|
General
and Administrative Pension Plan
|
17
|
93,982
|
|
Jeffrey
R. Hines
Chief
Operating Officer
|
Supplemental
Executive Retirement Plan
|
17
|
76,132
|
|
Duane
R. Close
Vice
President-Operations
|
General
and Administrative Pension Plan
|
30
|
437,764
|
|
Duane
R. Close
Vice
President-Operations
|
Supplemental
Executive Retirement Plan
|
24
|
228,289
|
|
Bruce
C. McIntosh
Vice
President-Human Resources
|
General
and Administrative Pension Plan
|
11
|
79,619
|
|
Bruce
C. McIntosh
Vice
President-Human Resources
|
Supplemental
Executive Retirement Plan
|
9
|
78,286
|
Name
and
Principal Position
|
Executive
Contribution
|
Company
Contribution
|
Earnings
|
Balance
at
Year-End
|
Jeffrey
S. Osman,
President,
Chief Executive Officer
and
Director
|
601
|
66,239
|
||
Kathleen
M. Miller,
Chief
Financial Officer
|
189
|
189
|
950
|
42,421
|
Jeffrey
R. Hines,
Chief
Operating Officer
|
1,818
|
81,405
|
||
Duane
R. Close,
Vice
President-Operations
|
508
|
71,153
|
||
Bruce
C. McIntosh,
Vice
President-Human Resources
|
769
|
42,473
|
Name
and
Principal
Position
|
Deferred
Income
Account Percentage (%)
|
Monthly
Retirement Amount ($)
|
|||
Jeffrey
S. Osman, President, Chief Executive Officer and Director
|
2.039
|
1,351
|
|||
Kathleen
M. Miller,
Chief
Financial Officer
|
0.651
|
276
|
|||
Jeffrey
R. Hines,
Chief
Operating Officer
|
1.110
|
904
|
|||
Duane
R. Close
Vice
President-Operations
|
2.032
|
1,446
|
|||
Bruce
C. McIntosh, Vice President-Human Resources
|
0.664
|
282
|
Name
and
Principal
Position
|
Lump
Sum Payment Upon Termination ($)
|
|
Jeffrey
S. Osman, President, Chief Executive Officer and Director
|
28,349
|
|
Kathleen
M. Miller,
Chief
Financial Officer
|
14,986
|
|
Jeffrey
R. Hines,
Chief
Operating Officer
|
39,250
|
|
Duane
R. Close
Vice
President-Operations
|
28,778
|
|
Bruce
C. McIntosh, Vice President-Human Resources
|
15,209
|
Name
and
Principal
Position
|
Lump
Sum Payment Upon Becoming Disabled ($)
|
|
Jeffrey
S. Osman, President, Chief Executive Officer and Director
|
58,517
|
|
Kathleen
M. Miller,
Chief
Financial Officer
|
18,293
|
|
Jeffrey
R. Hines,
Chief
Operating Officer
|
38,065
|
|
Duane
R. Close
Vice
President-Operations
|
53,410
|
|
Bruce
C. McIntosh, Vice President-Human Resources
|
17,880
|
Name
and
Principal
Position
|
Beneficiary
Death Benefit ($)
|
|
Jeffrey
S. Osman, President, Chief Executive Officer and Director
|
189,900
|
|
Kathleen
M. Miller,
Chief
Financial Officer
|
240,039
|
|
Jeffrey
R. Hines,
Chief
Operating Officer
|
425,014
|
|
Duane
R. Close
Vice
President-Operations
|
190,497
|
|
Bruce
C. McIntosh, Vice President-Human Resources
|
155,226
|
·
|
Any
person or affiliated group (with limited exceptions) becomes the
beneficial owner in the aggregate of 50 percent or more of all of our
voting securities;
|
·
|
A
majority of our Board of Directors is involuntarily removed or defeated
for re-election to our Board of Directors (for example, as a result of a
proxy contest);
|
·
|
We
are party to a merger or reorganization pursuant to which the holders of
our voting securities prior to such transaction become the holders of 50
percent or less of the voting securities of the new merged or reorganized
company; or
|
·
|
The
Company is liquidated or dissolved, or all of its assets are sold to a
third party;
|
·
|
misappropriation
of funds or any act of common law
fraud;
|
·
|
habitual
insobriety or substance abuse;
|
·
|
conviction
of a felony or any crime involving moral
turpitude;
|
·
|
willful
misconduct or gross negligence by the senior manager in the performance of
his duties;
|
·
|
the
willful failure of the senior manager to perform a material function of
his duties; or
|
·
|
the
senior manager engaging in a conflict of interest or other breach of
fiduciary duty.
|
·
|
the
Company has breached the change in control
agreement;
|
·
|
the
Company has significantly reduced the authority, duties or
responsibilities of the senior manager or reduced his base compensation or
annual bonus compensation
opportunity;
|
·
|
the
Company has reduced the senior manager from the employment grade or
officer positions which he or she holds;
or
|
·
|
the
Company has transferred the senior manager, without his or her express
written consent, to a location that is more than 50 miles from his or her
principal place of business immediately preceding the change of
control.
|
Name
|
Multiple
of Base Pay
|
Lump
Sum Payment Amount ($)
|
Health and Other Insurance
Benefits ($) (1)
|
Total
($)
|
||||
Kathleen
M. Miller
|
||||||||
Involuntary
termination or good reason termination.
|
.5
times
|
54,197
|
5,305
|
59,502
|
||||
Voluntary
termination more than 3 months but less than one year after a change in
control.
|
.25
times
|
27,099
|
5,305
|
32,404
|
||||
Continuing
employment for one year after a change in control.
|
.5
times
|
54,197
|
5,305
|
59,502
|
||||
Jeffrey
R. Hines
|
||||||||
Involuntary
termination or good reason termination.
|
.5
times
|
77,165
|
2,186
|
79,351
|
||||
Voluntary
termination more than 3 months but less than one year after a change in
control.
|
.25
times
|
38,582
|
2,186
|
40,768
|
||||
Continuing
employment for one year after a change in control.
|
.5
times
|
77,165
|
2,186
|
79,351
|
||||
Duane
R. Close
|
||||||||
Involuntary
termination or good reason termination.
|
.5
times
|
66,381
|
4,677
|
71,058
|
||||
Voluntary
termination more than 3 months but less than one year after a change in
control.
|
.25
times
|
33,191
|
4,677
|
37,868
|
||||
Continuing
employment for one year after a change in control.
|
.5
times
|
66,381
|
4,677
|
71,058
|
Name
|
Multiple
of Base Pay
|
Lump
Sum Payment Amount ($)
|
Health and Other Insurance
Benefits ($) (1)
|
Total
($)
|
||||
Bruce
C. McIntosh
|
||||||||
Involuntary
termination or good reason termination.
|
.5
times
|
52,057
|
4,566
|
56,623
|
||||
Voluntary
termination more than 3 months but less than one year after a change in
control.
|
.25
times
|
26,028
|
4,566
|
30,594
|
||||
Continuing
employment for one year after a change in control.
|
.5
times
|
52,057
|
4,566
|
56,623
|
·
|
participate
in the ownership, management, operation, control or financing of, or be
connected as an officer, director, employee, partner, principal, agent,
representative, consultant or otherwise with or use or permit his or her
name to be used in connection with, any business or enterprise engaged in
by us within our franchised
territory;
|
·
|
solicit
or attempt to convert any account or customer of the Company to another
supplier; or
|
·
|
solicit
or attempt to hire any employee of the
Company.
|
Name
|
Plan Name
|
Monthly
Benefit ($)
|
Jeffrey
S. Osman
|
General
and Administrative Pension Plan
|
6,647
|
Jeffrey
S. Osman
|
Supplemental
Executive Retirement Plan
|
2,778
|
Kathleen
M. Miller
|
General
and Administrative Pension Plan
|
1,423
|
Kathleen
M. Miller
|
Supplemental
Executive Retirement Plan
|
465
|
Jeffrey
R. Hines
|
General
and Administrative Pension Plan
|
2,934
|
Jeffrey
R. Hines
|
Supplemental
Executive Retirement Plan
|
2,162
|
Duane
R. Close
|
General
and Administrative Pension Plan
|
4,865
|
Duane
R. Close
|
Supplemental
Executive Retirement Plan
|
2,469
|
Bruce
C. McIntosh
|
General
and Administrative Pension Plan
|
1,456
|
Bruce
C. McIntosh
|
Supplemental
Executive Retirement Plan
|
1,316
|
Director
|
Fees
Earned
Paid in Cash
|
All
Other
Compensation
|
Total
Compensation
|
William
T. Morris
|
|||
Chairman
of the Board
|
22,870
|
28,358
|
51,228
|
Irvin
S. Naylor
|
|||
Vice
Chairman of the Board
|
22,200
|
15,448
|
37,648
|
John
L. Finlayson
|
26,315
|
26,315
|
|
Michael
W. Gang
|
25,215
|
25,215
|
|
Thomas
C. Norris
|
26,690
|
26,690
|
|
George
W. Hodges
|
22,500
|
22,500
|
|
Chloè
R. Eichelberger
|
5,390
|
5,390
|
|
George
Hay Kain III
|
18,410
|
18,410
|
|
Ernest
J. Waters
|
7,450
|
7,450
|
John
L. Finlayson, Chairman
|
George
W. Hodges, Member
|
|
Ernest
J. Waters, Member
|
Thomas
C. Norris, Member
|
2007
|
2006
|
|||
Audit
Fees (1)
|
99,900
|
137,525
|
||
Audit
Related Fees
|
0
|
0
|
||
Tax
Fees (2)
|
9,100
|
8,750
|
||
All
Other Fees
|
0
|
0
|
||
109,000
|
146,275
|
VOTE
BY INTERNET - www.proxyvote.com
Use the Internet to transmit your voting instructions and for electronic
delivery of information up until 11:59 P.M. Eastern Time the day before
the
cut-off date or meeting date. Have your proxy card in hand when you
access the web site and follow the instructions to obtain your records and
to create an electronic voting instruction form.
ELECTRONIC
DELIVERY OF FUTURE SHAREHOLDER COMMUNICATIONS
If
you would like to reduce the costs incurred by The York Water Company in
mailing proxy materials, you can consent to receiving all future
proxy
statements,
proxy cards and annual reports electronically via e-mail or the Internet.
To sign up for electronic delivery, please follow the instructions above
to vote using the Internet and, when prompted, indicate that you agree to
receive or access shareholder communications electronically in
future years.
VOTE
BY PHONE - 1-800-690-6903
Use
any touch-tone telephone to transmit your voting instructions up
until
11:59
P.M. Eastern Time the day before the cut-off date or meeting date. Have
your proxy card in hand when you call and then follow the
instructions.
VOTE
BY MAIL
Mark, sign and date your proxy card and return it in the postage-paid
envelope we have provided or return it to The York Water Company, c/o
Broadridge, 51 Mercedes Way, Edgewood, NY
11717
|
THE
YORK WATER COMPANY
|
|||||||||||
Directors
recommend a vote FOR all the nominees listed.
|
|||||||||||
Vote
On Directors
|
|||||||||||
1.
|
ELECTION
OF DIRECTORS
|
For
All
|
Withhold
All
|
For
All Except
|
To
withhold authority to vote for any individual nominee(s), mark “For All
Except” and write the number(s) of the nominee(s) on the line
below.
|
||||||
Nominees:
|
|||||||||||
01)
|
John
L. Finlayson
|
O
|
O
|
O
|
|||||||
02)
|
Thomas
C. Norris
|
||||||||||
03)
|
Ernest
J. Waters
|
||||||||||
Vote
On Proposal
|
For
|
Against
|
Abstain
|
||||||||
2.
|
Appoint
Beard Miller Company LLP as auditors.
|
O
|
O
|
O
|
|||||||
3.
|
DISCRETIONARY
AUTHORITY
|
||||||||||
To
transact such other business as may properly come before the Meeting and
any adjournment
|
|||||||||||
thereof
according to the proxies’ discretion and in their
discretion.
|
|||||||||||
To
cumulate votes as to a particular nominee as explained in the Proxy
Statement, check box to the right then indicate the name(s) and the number
of votes to be given to such nominee(s) on the reverse side of this
card. Please do not check box unless you want to exercise
cumulative voting.
|
O
|
||||||||||
Please
indicate if you plan to attend this meeting.
|
O
|
O
|
|||||||||
Yes
|
No
|
||||||||||
NOTE: Please
sign exactly as your name or names appear on this Proxy. When
shares are held jointly, each holder should sign. When signing
as executor, administrator, attorney, trustee or guardian, please give
full title as such. If the signer is a corporation, please sign
full corporate name by duly authorized officer, giving full title as
such. If signer is a partnership, please sign in partnership
name by authorized person.
|
|||||||||||
Signature
(PLEASE SIGN WITHIN BOX)
|
Date
|
Signature
(Joint Owners)
|
Date
|