293-22 Exhibit A.pdf

Article 3.01 STOCKHOLDER DISCLOSURE CERTIFICATION I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. _________ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. __________ PLEASE CHECK TYPE OF BUSINESS ORGANIZATION: Partnership _____ Limited Partnership _____ Limited Liability Corp. _____ Corporation _____ Sole Proprietorship_____ Limited Liability Partnership_____ Subchapter S Corp. _____ PLEASE CHECK APPROPRIATE BOXES AND SIGN BELOW Stockholders NAME: ______________________________________________ HOME ADDRESS: ____________________________________ ____________________________________ NAME: ______________________________________________ HOME ADDRESS: ____________________________________ _______________________________________ NAME: ______________________________________________ HOME ADDRESS: _____________________________________ ______________________________________ 34