Disclosure Authorization Form {RD-1062}

000002003004005006007btn013f005r006016017020005n021022fn022t023024005005005005005005005005005005005005005005005005005005005025026027016005t005005005005005005030016002003027031026005007016032026003033004016034033005002035005006016017016034036016005005005005007031037 !002037036003016005"036033#002003031$026033031002034005000002003004005005005%036&004031033005033#031037005035002003004005033002005033#016005007016032026003033004016034033005016004032!002'016016005#026034(!031034027005'002036003005031034)036031003'020005005 %016 033031002034005t005*026+032026'016003005,034035002003004026033031002034005 -./0.1230054 .52005664789:4005-2;20<=>20054?5@23005 60=?A2BA0054 .52005CDE005F=D>G005D>H=52005G./00532G?3>I00560=?A2BA005664005CDE005.00;DH.@;2I005-2;20<=>20054?5@23005CDE005.00;DH .@;2I005 J.D;D>K005LMM 32AA005 60=?A2BA005J .D;D>K005LMM32AA005CDE005MDEE232>G005E3=5005.@=N2I005 %016 033031002034005f005 "032032002031034033016016005,034035002003004026033031002034005 4.52005=E005L0 0=D>G22005-2;20<=>20054?5@2300595.D;005LMM32AA005 J.D;D>K005LMM 32AA005 %016 033031002034005O005 *026+005P026033033016003037005 -<2005.00=D>G2 2005DA005.?G<=3DQ2M005G=00532H2DN2005H=>EDM2>GD.;005D>E=35.GD=>005E=3005G<2005G./0055.GG23CAI005;DAG2M005@2;=RS005 *026+005*'032016 005*026+005T016026003r037024005002003005025016003031002(r037024005 :>MDNDM?.; 005:>H=52005-./005005 6.;2A005.>M 005UA2005-./005005 V=30=3.G2 005:>H=52005-./005005 WDG<<=;MD >K005-./005005 XG<23005CA0 2HDE1I005005 005 %016 033031002034005Y005 %031027034026033036003016005002035005*026+032026'016003005 :005<232@1005H23 GDE1005G<.G005G<2005Z2=3KD.005[20.3G52>G005=E005\2N2>?2005DA005.?G<=3DQ2M005G=005MDAH;=A2005.>M7=3005MDAH?AA005H=>EDM2>GD.;005D>E=35.GD= >005=300532H=3MA005H=>H23>D>K005G <2005?>M23ADK>2M005G./0.123005G=005G<2005.00=D>G22005>.52M005.@=N2005E=3005G<2005G./005G102CAI005.>M005023D=MCAI005;DAG2M005.@=N2] 005 :E005 ADK>2M005@1005.005H=30=3.G2005=EE DH23^0050.3G>23^005525@23^005G3?AG22^005=30052/2H?G=372/2H?G3D/005=>005@2<.;E005=E005G<2005G./0.123^005:005H23GDE1005G<.G005:005<.N2005G<2005.?G<=3D G1005G=0052/2H?G2005G<DA005E=35005=>005 @2<.;E005=E005G<2005G./0.123]005:005?>M23AG.>M005G<.G005G=005RD;;E?;;10050320.32005=3005032A2>G005.005M=H?52>G005G<.G005DA005E3.?M?;2>G005=3005E.;A 2005DA005.005E2;=>1005?>M23005X]V]Z ]L]005005`ab`cbdc]005 0056DK>.G?32005 e3D>G0054.52005[.G2005-DG;2005CDE005H=30=3.G2005=EEDH23I005 00560=?A2BA0056 DK>.G?32005e3D>G00560=?A2BA0054.52005[.G2005 " f034002g!016( 027016004016034033005002035005007031037 !002037036003016005"036033#002003031$026033031002034020005-<2005023A=>CAI005ADK>D>K005.A005G<2005G./0.123005.@=N2005.002.32M005G<DA005M.1005@2E =32005.005>=G.310050?@;DH005.>M005. Hh>=R;2MK2M005G<DA005[DAH;=A?32005L?G<=3DQ.GD=>0058=35005.A005.005N=;?>G.31005.HG005.>M005M22M]005 6R=3>005 .>M005A?@AH3D@2M005@2E=3200552005G<DA005iiiiiiiiii005M.1005=E005iiiiiiiiiiiiiiiiiiiiii^005dciiiiiiii]005 0056DK>.G?32005= E0054=G.310054=G.3100562.;005 %016 033031002034005j005 k+032031003026033031002034005l032002034005007031037 !002037036003016005r000002003005,034033016003034026!005007016032026003033004016034033005l037016005m034!'024005 -<DA005MDAH;=A? 32005.?G<=3DQ.GD=>005E=35005RD;;005.?G=5.GDH.;;10052/0D32005=>H2005G<2005[20.3G52>G005<.A005MDAH;=A2M005.;;005.00;DH.@;2005D>E=35.GD=>005G= 005G<2005.00=D>G22]005 950;=122005J.hD>K005[DAH;=A?32S005[.G2005=E005[DAH;=A?32S005 005 American LegalNet, Inc. www.FormsWorkFlow.com 000002003004005006005007btn005013fr016017020006005f021022023024b022025t004005026025027030bt021031002027021b032005007btn005005000025t033b022004005b034005007btn005 035005036037 !037"#$005%037"005&'#005()$%005*+,-./0005036)005037&0361)$23#0050361#0054#)$52037005+#!037$036%#6036005)7005*#8#6&#005036)00592':;)'#005:)6729#60362037;005036037 005267)$%0370362)6 005036)0050376005037!!)26036##0057)$005037005'!#:272:005036037 005036"!#<'=00503769005!#$2)9<'=>005005()$%005*+,-./0005:03766)036005 ?#005&'#9005037'005037005@)A#$005)7005035036036)$ 6#"005<'##005()$%005*+,-./-=005037690050361&'0059)#'0056)0360055$03760360050361#005037!!)26036##0050376"005!)A#$'005)7005$#! $#'#60360370362)6>005B037 !037"#$'005'1 )&;9005)6;"005&'#00503612'0057)$%005A1#6005'&?%2036036265005037005'!#:272:005$#C&#'0360057)$005037005)6#,0362%#0059 2':;)'&$#005)7005267)$%0370362)6>005005005007021024021032003005D032022027t025023 027021b032022005 E&?%2036005()$%005* +,-./0005036)0050361#005+#!037$036%#6036005#%!;)"##005103769;265005")&$00526C&2$">005 005F033004023021034021023005D032022027t 025023027021b032022005 F004023027021b032005016005G005H 002I033002J004t005D032034btn002027021b032005 K6036#$0050361#0056037% #L00503799$#''L005037690050376"005037!!;2:037?;#00529#6036272:0370362)60056&%?#$'005)70050361#005036037 !037"#$>005005M70050361#005036037 !037"#$0052'00503760052692829&037;L005#6036# $0050361#0057&;;005E):2037;005E#:&$2036"0056&%?#$005<EEN=>005005M70050361#005036037 !037"#$0052'005037005?&'26#''005#60362036"L005#6036# $0050361#005(#9#$037;005K%!;)"#$005M9#6 036272:0370362)6005N&%?#$005<(KMN=>005005M70050361#005036037 !037"#$0052'0055$0376036265005037::#''005036)005037005O)26036005$#036&$6L005#6036#$ 0050361#005'!)&'#P'0056037%#L00503799$#' 'L005037690057&;;005EEN>005005 F004023027021b032005006005G005026 033033b021032027004004005D032034btn002027021b032005 K6036#$0050361#005037!! )26036##Q'0056037%#L00503799$#''L00503769005:)6036037:036005267)$%0370362)6>0050050356005037!!)26036##005%&'036005?#0050376005269 2829&037;L0056)036005037005?&'26#''005#60362036 ">005005M70059#'256037036265005037&0361)$2036"005036)005%)$#00503610376005)6#005037!!)26036##L00572;#00503760050379920362)6037;005()$%005*+ ,-./0>005005005F004023027021b032005R005G005H 002I005S002027027004t022005 K6036#$0050361#005036037 005 036"!#<'=00503769005'!#:272:005!#$2)9<'=005)$005"#037$<'=0057)$005A12:10050361#005037&0361)$230370362)60052'0055$0376036#9 >0050050350055#6#$037;005$#7#$#6:#005036)005T037 ;;005"#037$'T005)$005T037;;005!#$2)9'T005)$0057&036&$#0059037036#'0052'0056)036005037::#!036037?;#>005 F004023027021b032005U005G005F 021003032002027025t004005b034005H002I033002J004t005 B1#005036037 !037"#$005 %&'036005'25600526005E#:0362)6005V0057)$005()$%005*+,-./0005036)005?#005#77#:03628#>005005B1#005036037?;#005?#;)A005'1)A '005A1)005'1)&;9005'2560057)$005#037:1005036 "!#005)7005036037 !037"#$W005 H002I033002J004t005 X030b005S025022027005F021003032005 M692829&037;'005 B1#0052692829&037;Y');#005!$)!$2#036)$005%&'036005'256005<270055$0376036265005037::#''005036)005037 005O)26036005 $#036&$6L005'!)&'#005%&'036005037;')005'256=>005005 Z)$!)$0370362)6' 005035005:)$!)$037036#005)772:#$005A20361005037&0361)$2036"005036)005'256>005005 @037$0366#$'12!' 005035005!037$0366#$00510378265005037&0361)$2036"005036)005037:036005260050361#0056037%#005)70050361#005!037$0366#$'12! 005%&'036005'256>005005 [2%2036#9005[2037?2; 2036"005Z)%!03762#'005035005%#%?#$00510378265005037&0361)$2036"005036)005037:036005260050361#0056037%#005)70050361#005:)%!0376"005% &'036005'256>005005 B$&'036'005 035005036$&'036##005%&'036005'256>005 K'036037036#'005 0356005# #:&036)$Y# #:&036$2 005)70050361#005!#$')6037;005$#!$#'#603603703628#005)70050361#005#'036037 036#005%&'036005 '256>005005 005B12'005()$%005*+ ,-./0005%&'036005?#0056)036037$23#9005&6;#''00520360052'005?#265005!$#'#6036#9005?"0050370057#9#$037;0050375#6036005A1)0052'0058 #$272#9005?"0050361#005+#!037$036%#6036>005005F004023027021b032005\005G005] I033021t002027021b032005^033b032005f021022023024b022025t004005 035005()$%005*+,-. /0005%037"005)6;"005?#005&'#90057)$005037005)6#,0362%#00592':;)'&$#005)7005:#$03603726005036037 005267)$%0370362)6>005B1&'L005( )$%005*+,-./0005A2;;005# !2$#005&!) 600592':;)'&$#005036)0050361#005037!!)26036##>005()$0050376"005'&?'#C&#603600592':;)'&$#'L0050370056#A005()$%005*+,- ./0005%&'036005?#00572;#9>005005005M0360052'0052%!)$0360376036005036)0056)036#00503610370360050361#00572;265005)7005037005()$%005*+,-./000592':;)'&$#005037&0361)$230370362)6005021024024005032b027005$#8)`#0050376"005@)A#$005)7005035036036)$6#"005<()$%005*+,-./-=005)$005*#!)$0362650050355#6036005035&0361)$230370362)6005<()$%005*+,-./a=00503610370360052'00526005#77#:036>005005 American LegalNet, Inc. www.FormsWorkFlow.com