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Read carefully all of the statements on this page. When you have read and understood all of the statements on this page, enter your name and title information to certify that you agree with all of the statements.
Note: Failure to sign this application may result in dismissal of the application and forfeiture of any fees paid.
Once you have read and signed the certification statement, click Send to Assignor. The application is now ready for the assignor to certify and submit the application to the Commission.
