%PDF-1.6
%
1 0 obj
<>stream
application/pdf
Meir Lipnick
Form 8655 (Rev. August 2014)
2017-11-21T09:32:02
PScript5.dll Version 5.2.2
2017-11-21T09:38:16-06:00
2017-11-21T09:38:16-06:00
GPL Ghostscript 8.15
uuid:83860b67-0129-4b28-b59a-4357bbf6ae77
uuid:f6723791-77d4-42f9-b0a8-e6dea5c78a3b
endstream
endobj
2 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
3 0 obj<>
endobj
4 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
5 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
6 0 obj
<>/Length 18>>stream
xPpuVpb
endstream
endobj
7 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 89>>stream
x;
0Qjm <? !SC\؏x½2p;S3SA7q^M҅ħz*=m|b
endstream
endobj
8 0 obj<>
endobj
9 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
10 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
11 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
12 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
13 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
14 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
15 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
16 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 18>>stream
xPpuVpb
endstream
endobj
17 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text2)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
18 0 obj<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/CropBox[0 0 612 792]>>
endobj
28 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text3)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
29 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text4)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
30 0 obj<>/FT/Btn/AP<>>>/Subtype/Widget/T(Check Box1)/DA(/ZaDb 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4/AS/Off>>
endobj
31 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text5)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
32 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text6)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
33 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text7)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
34 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text8)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
35 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text9)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
36 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text10)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
37 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text11)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
38 0 obj<>/FT/Tx/Ff 8388608/AP<>/Subtype/Widget/T(Text12)/DA(/HeBo 0 Tf 0 0 0 rg )/P 18 0 R/DR<>>>/MK<>/F 4>>
endobj
42 0 obj
<>stream
application/pdf
Meir Lipnick
Form 8655 (Rev. August 2014)
2017-11-21T09:32:02
PScript5.dll Version 5.2.2
2017-11-21T09:38:16-06:00
2017-11-21T09:38:16-06:00
GPL Ghostscript 8.15
uuid:83860b67-0129-4b28-b59a-4357bbf6ae77
uuid:f6723791-77d4-42f9-b0a8-e6dea5c78a3b
endstream
endobj
43 0 obj
<>stream
application/pdf
Meir Lipnick
Form 8655 (Rev. August 2014)
2017-11-21T09:32:02
PScript5.dll Version 5.2.2
2017-11-21T09:38:16-06:00
2017-11-21T09:38:16-06:00
GPL Ghostscript 8.15
uuid:83860b67-0129-4b28-b59a-4357bbf6ae77
uuid:f6723791-77d4-42f9-b0a8-e6dea5c78a3b
endstream
endobj
44 0 obj<>
endobj
45 0 obj<>
endobj
46 0 obj<>
endobj
27 0 obj<>
endobj
47 0 obj<>/OCProperties<>>>/AcroForm 49 0 R>>
endobj
48 0 obj<>
endobj
49 0 obj<>/Font<>>>/Fields[17 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R]>>
endobj
19 0 obj
<>stream
HWgsE~b Z֓9ؘG62T鞰ӽwe*igw6bj[~~9!?6V
//}zg77aZk7oߛGL PBM"I/&Aͭ,QCoʅg6v1awi7 Sp=|{rG1Lp%ae]Z9Vzƣ2Wb+EeP
(Avv4,&pqѦ/+WVMX2i[m+H0ÙF--Fi85E#QԣpFcOAe9E';sFmKZjTHOiؘD(dO+9`;e\rōzRO̴Q+3IRbVu"䥛EQEs$l
JjLof*1+APg2s֢Ni腮F.DrA/SRԔ=Zk6Tf;lp@\w)dzv(@UwqD-tkY ;,sŰKX{d.ӧT^:[u`0P q 3<=j#rmϵ;'0\@#~~9&60p3U WHs97KD#8(i_h[Ԡ*N& 0
cIMҚ) Nzr*7=~m,FĴO! TZ@hHHOhсa> 1c'lKc4ż[`+3!'ϫ$bχD]AHpk,ȩ7Z$ }lp*+3,:C,9Vi-x}rYQxwHpGPﵽg<4>/5Q68.di>hvrPrgnޒ.\;>\a!@l
)K0yL`Q`l 18Q|1*3 r*dp@ ïG!ھ1O3bUaoڞosfBps眸 B
B"<
خVYk4 c,.di}.$$?hfv,;&B[@Iwy7e?
LKTtLPqU[M*&dY)
<c҆PsBZJ%\w .伷:T^| jRٖ-474͜k