Jose Martinez v. Charles L. Beck

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UNITED STATES DISTRICT COURT

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CENTRAL DISTRICT OF CALIFORNIA

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JOSE MARTINEZ, an individual Case No. CV19-02101 ODW (GJSx)

11 Hon. Otis D. Wright, II, Ctrm. 5D, 5th Fl.

Plaintiff, Mag. Gail J. Standish, Ctrm. 640, 6th Fl.

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v.

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14 STIPULATED PROTECTIVE

CHARLES L. BECK, an individual, ORDER1

15 MICHEL R. MOORE, an individual;

JERITT SEVERNS, an individual;

16 LOS ANGELES POLICE

DEPARTMENT, a government

17 agency; COUNTY OF LOS

ANGELES, a political body, CITY OF

18 LOS ANGELES, a political body,

STATE OF CALIFORNIA, and DOES

19 1 through 50, inclusive,

20 Defendant.

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1. A. PURPOSES AND LIMITATIONS

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Discovery in this action is likely to involve production of confidential,

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proprietary or private information for which special protection from public

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disclosure and from use for any purpose other than prosecuting this litigation may

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1 be warranted. Accordingly, the parties hereby stipulate to and petition the Court to

2 enter the following Stipulated Protective Order. The parties acknowledge that this

3 Order does not confer blanket protections on all disclosures or responses to

4 discovery and that the protection it affords from public disclosure and use extends

5 only to the limited information or items that are entitled to confidential treatment

6 under the applicable legal principles.

7 B. GOOD CAUSE STATEMENT

8 This action involves the City of Los Angeles, the Los Angeles Police

9 Department, Charles L. Beck, Michel R. Moore, Jeritt Severns, and the County of

10 Los Angeles (“Defendants”). Plaintiffs are seeking materials and information that

11 Defendant City of Los Angeles and Los Angeles Police Department (“City”)

12 maintains as confidential, such as personnel files of the police officers involved in

13 this incident, Internal Affairs materials and information, video recordings, audio

14 recordings, and information and other administrative materials and information

15 currently in the possession of the City which may be entitled to special protection

16 from public disclosure and from use for any purpose other than prosecuting this

17 litigation.

18 Accordingly, to expedite the flow of information, to facilitate the prompt

19 resolution of disputes over confidentiality of discovery materials, to adequately

20 protect information the parties are entitled to keep confidential, to ensure that the

21 parties are permitted reasonable necessary uses of such material in preparation for

22 and in the conduct of trial, to address their handling at the end of the litigation, and

23 serve the ends of justice, a protective order for such information is justified in this

24 matter. It is the intent of the parties that information will not be designated as

25 confidential for tactical reasons and that nothing be so designated without a good

26 faith belief that it has been maintained in a confidential, non-public manner, and

27 there is good cause why it should not be part of the public record of this case. This

1 information; (2) copies, excerpts, summaries or compilations of Confidential

2 information; and (3) any testimony, conversations, or presentations that might

3 reveal Confidential information.

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5 C. ACKNOWLEDGMENT OF PROCEDURE FOR FILING UNDER SEAL

6 The parties further acknowledge, as set forth in Section 12.3, below, that this

7 Stipulated Protective Order does not entitle them to file confidential information

8 under seal; Local Civil Rule 79-5 sets forth the procedures that must be followed

9 and the standards that will be applied when a party seeks permission from the court

10 to file material under seal.

11 There is a strong presumption that the public has a right of access to judicial

12 proceedings and records in civil cases. In connection with non-dispositive motions,

13 good cause must be shown to support a filing under seal. See Kamakana v. City and

14 County of Honolulu, 447 F.3d 1172, 1176 (9th Cir. 2006), Phillips v. Gen. Motors

15 Corp., 307 F.3d 1206, 1210-11 (9th Cir. 2002), Makar-Welbon v. Sony Electrics,

16 Inc., 187 F.R.D. 576, 577 (E.D. Wis. 1999) (even stipulated protective orders

17 require good cause showing), and a specific showing of good cause or compelling

18 reasons with proper evidentiary support and legal justification, must be made with

19 respect to Protected Material that a party seeks to file under seal. The parties’ mere

20 designation of Disclosure or Discovery Material as CONFIDENTIAL does not—

21 without the submission of competent evidence by declaration, establishing that the

22 material sought to be filed under seal qualifies as confidential, privileged, or

23 otherwise protectable—constitute good cause.

24 Further, if a party requests sealing related to a dispositive motion or trial, then

25 compelling reasons, not only good cause, for the sealing must be shown, and the

26 relief sought shall be narrowly tailored to serve the specific interest to be protected.

27 See Pintos v. Pacific Creditors Ass’n, 605 F.3d 665, 677-79 (9th Cir. 2010). For

1 under seal in connection with a dispositive motion or trial, the party seeking

2 protection must articulate compelling reasons, supported by specific facts and legal

3 justification, for the requested sealing order. Again, competent evidence supporting

4 the application to file documents under seal must be provided by declaration.

5 Any document that is not confidential, privileged, or otherwise protectable in

6 its entirety will not be filed under seal if the confidential portions can be redacted.

7 If documents can be redacted, then a redacted version for public viewing, omitting

8 only the confidential, privileged, or otherwise protectable portions of the document,

9 shall be filed. Any application that seeks to file documents under seal in their

10 entirety should include an explanation of why redaction is not feasible.

11 2. DEFINITIONS

12 2.1 Action: this pending federal lawsuit.

13 2.2 Challenging Party: a Party or Non-Party that challenges the

14 designation of information or items under this Order.

15 2.3 “CONFIDENTIAL” Information or Items: information (regardless of

16 how it is generated, stored or maintained) or tangible things that qualify for

17 protection under Federal Rule of Civil Procedure 26(c), and as specified above in

18 the Good Cause Statement. This also includes (1) any information copied or

19 extracted from the Confidential information; (2) copies, excerpts, summaries or

20 compilations of Confidential information; and (3) any testimony, conversations, or

21 presentations that might reveal Confidential information.

22 2.4 Counsel: Outside Counsel of Record and House Counsel (as well as

23 their support staff).

24 2.5 Designating Party: a Party or Non-Party that designates information or

25 items that it produces in disclosures or in responses to discovery as

26 “CONFIDENTIAL.”

27 2.6 Disclosure or Discovery Material: all items or information, regardless

1 among other things, testimony, transcripts, and tangible things), that are produced or

2 generated in disclosures or responses to discovery in this matter.

3 2.7 Expert: a person with specialized knowledge or experience in a matter

4 pertinent to the litigation who has been retained by a Party or its counsel to serve as

5 an expert witness or as a consultant in this Action.

6 2.8 House Counsel: attorneys who are employees of a party to this Action.

7 House Counsel does not include Outside Counsel of Record or any other outside

8 counsel.

9 2.9 Non-Party: any natural person, partnership, corporation, association or

10 other legal entity not named as a Party to this action.

11 2.10 Outside Counsel of Record: attorneys who are not employees of a

12 party to this Action but are retained to represent or advise a party to this Action and

13 have appeared in this Action on behalf of that party or are affiliated with a law firm

14 that has appeared on behalf of that party, and includes support staff.

15 2.11 Party: any party to this Action, including all of its officers, directors,

16 employees, consultants, retained experts, and Outside Counsel of Record (and their

17 support staffs).

18 2.12 Producing Party: a Party or Non-Party that produces Disclosure or

19 Discovery Material in this Action.

20 2.13 Professional Vendors: persons or entities that provide litigation

21 support services (e.g., photocopying, videotaping, translating, preparing exhibits or

22 demonstrations, and organizing, storing, or retrieving data in any form or medium)

23 and their employees and subcontractors.

24 2.14 Protected Material: any Disclosure or Discovery Material that is

25 designated as “CONFIDENTIAL.”

26 2.15 Receiving Party: a Party that receives Disclosure or Discovery

27 Material from a Producing Party.

3. SCOPE

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The protections conferred by this Stipulation and Order cover not only

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Protected Material (as defined above), but also (1) any information copied or

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extracted from Protected Material; (2) all copies, excerpts, summaries, or

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compilations of Protected Material; and (3) any testimony, conversations, or

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presentations by Parties or their Counsel that might reveal Protected Material.

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Any use of Protected Material at trial shall be governed by the orders of the

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trial judge. This Order does not govern the use of Protected Material at trial.

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4. DURATION

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FINAL DISPOSITION of the action is defined as the conclusion of any

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appellate proceedings, or, if no appeal is taken, when the time for filing of an appeal

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has run. Except as set forth below, the terms of this protective order apply through

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FINAL DISPOSITION of the action. The parties may stipulate that the they will be

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contractually bound by the terms of this agreement beyond FINAL DISPOSITION,

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but will have to file a separate action for enforcement of the agreement once all

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proceedings in this case are complete.

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Once a case proceeds to trial, information that was designated as

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CONFIDENTIAL or maintained pursuant to this protective order used or introduced

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as an exhibit at trial becomes public and will be presumptively available to all

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members of the public, including the press, unless compelling reasons supported by

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specific factual findings to proceed otherwise are made to the trial judge in advance

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of the trial. See Kamakana, 447 F.3d at 1180-81 (distinguishing “good cause”

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showing for sealing documents produced in discovery from “compelling reasons”

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standard when merits-related documents are part of court record). Accordingly, for

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such materials, the terms of this protective order do not extend beyond the

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commencement of the trial.

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5. DESIGNATING PROTECTED MATERIAL

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1 Each Party or Non-Party that designates information or items for protection under

2 this Order must take care to limit any such designation to specific material that

3 qualifies under the appropriate standards. The Designating Party must designate for

4 protection only those parts of material, documents, items or oral or written

5 communications that qualify so that other portions of the material, documents, items

6 or communications for which protection is not warranted are not swept unjustifiably

7 within the ambit of this Order.

8 Mass, indiscriminate or routinized designations are prohibited. Designations

9 that are shown to be clearly unjustified or that have been made for an improper

10 purpose (e.g., to unnecessarily encumber the case development process or to impose

11 unnecessary expenses and burdens on other parties) may expose the Designating

12 Party to sanctions.

13 If it comes to a Designating Party’s attention that information or items that it

14 designated for protection do not qualify for protection, that Designating Party must

15 promptly notify all other Parties that it is withdrawing the inapplicable designation.

16 5.2 Manner and Timing of Designations. Except as otherwise provided in

17 this Order (see, e.g., second paragraph of section 5.2(a) below), or as otherwise

18 stipulated or ordered, Disclosure or Discovery Material that qualifies for protection

19 under this Order must be clearly so designated before the material is disclosed or

20 produced.

21 Designation in conformity with this Order requires:

22 (a) for information in documentary form (e.g., paper or electronic

23 documents, but excluding transcripts of depositions or other pretrial or trial

24 proceedings), that the Producing Party affix at a minimum, the legend

25 “CONFIDENTIAL” (hereinafter “CONFIDENTIAL legend”), to each page that

26 contains protected material. If only a portion of the material on a page qualifies for

27 protection, the Producing Party also must clearly identify the protected portion(s)

1 A Party or Non-Party that makes original documents available for inspection

2 need not designate them for protection until after the inspecting Party has indicated

3 which documents it would like copied and produced. During the inspection and

4 before the designation, all of the material made available for inspection shall be

5 deemed “CONFIDENTIAL.” After the inspecting Party has identified the

6 documents it wants copied and produced, the Producing Party must determine which

7 documents, or portions thereof, qualify for protection under this Order. Then,

8 before producing the specified documents, the Producing Party must affix the

9 “CONFIDENTIAL legend” to each page that contains Protected Material. If only a

10 portion of the material on a page qualifies for protection, the Producing Party also

11 must clearly identify the protected portion(s) (e.g., by making appropriate markings

12 in the margins).

13 (b) for testimony given in depositions that the Designating Party identifies

14 the Disclosure or Discovery Material on the record, before the close of the

15 deposition all protected testimony.

16 (c) for information produced in some form other than documentary and

17 for any other tangible items, that the Producing Party affix in a prominent place on

18 the exterior of the container or containers in which the information is stored the

19 legend “CONFIDENTIAL.” If only a portion or portions of the information

20 warrants protection, the Producing Party, to the extent practicable, shall identify the

21 protected portion(s).

22 5.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent

23 failure to designate qualified information or items does not, standing alone, waive

24 the Designating Party’s right to secure protection under this Order for such material.

25 Upon timely correction of a designation, the Receiving Party must make reasonable

26 efforts to assure that the material is treated in accordance with the provisions of this

27 Order.

1 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS

2 6.1 Timing of Challenges. Any Party or Non-Party may challenge a

3 designation of confidentiality at any time that is consistent with the Court’s

4 Scheduling Order.

5 6.2 Meet and Confer. The Challenging Party shall initiate the dispute

6 resolution process under Local Rule 37.1 et seq.

7 6.3 The burden of persuasion in any such challenge proceeding shall be on

8 the Designating Party. Frivolous challenges, and those made for an improper

9 purpose (e.g., to harass or impose unnecessary expenses and burdens on other

10 parties) may expose the Challenging Party to sanctions. Unless the Designating

11 Party has waived or withdrawn the confidentiality designation, all parties shall

12 continue to afford the material in question the level of protection to which it is

13 entitled under the Producing Party’s designation until the Court rules on the

14 challenge.

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16 7. ACCESS TO AND USE OF PROTECTED MATERIAL

17 7.1 Basic Principles. A Receiving Party may use Protected Material that is

18 disclosed or produced by another Party or by a Non-Party in connection with this

19 Action only for prosecuting, defending or attempting to settle this Action. Such

20 Protected Material may be disclosed only to the categories of persons and under the

21 conditions described in this Order. When the Action has been terminated, a

22 Receiving Party must comply with the provisions of section 13 below (FINAL

23 DISPOSITION).

24 Protected Material must be stored and maintained by a Receiving Party at a

25 location and in a secure manner that ensures that access is limited to the persons

26 authorized under this Order.

27 7.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless

1 Receiving Party may disclose any information or item designated

2 “CONFIDENTIAL” only to:

3 (a) the Receiving Party’s Outside Counsel of Record in this Action, as

4 well as employees of said Outside Counsel of Record to whom it is reasonably

5 necessary to disclose the information for this Action;

6 (b) the officers, directors, and employees (including House Counsel) of

7 the Receiving Party to whom disclosure is reasonably necessary for this Action;

8 (c) Experts (as defined in this Order) of the Receiving Party to whom

9 disclosure is reasonably necessary for this Action and who have signed the

10 “Acknowledgment and Agreement to Be Bound” (Exhibit A);

11 (d) the court and its personnel;

12 (e) court reporters and their staff;

13 (f) professional jury or trial consultants, mock jurors, and Professional

14 Vendors to whom disclosure is reasonably necessary for this Action and who have

15 signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A);

16 (g) the author or recipient of a document containing the information or a

17 custodian or other person who otherwise possessed or knew the information;

18 (h) during their depositions, witnesses, and attorneys for witnesses, in the

19 Action to whom disclosure is reasonably necessary provided: (1) the deposing party

20 requests that the witness sign the form attached as Exhibit 1 hereto; and (2) they will

21 not be permitted to keep any confidential information unless they sign the

22 “Acknowledgment and Agreement to Be Bound” (Exhibit A), unless otherwise

23 agreed by the Designating Party or ordered by the court. Pages of transcribed

24 deposition testimony or exhibits to depositions that reveal Protected Material may

25 be separately bound by the court reporter and may not be disclosed to anyone except

26 as permitted under this Stipulated Protective Order; and

27 (i) any mediator or settlement officer, and their supporting personnel,

1 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED

2 IN OTHER LITIGATION

3 If a Party is served with a subpoena or a court order issued in other litigation

4 that compels disclosure of any information or items designated in this Action as

5 “CONFIDENTIAL,” that Party must:

6 (a) promptly notify in writing the Designating Party. Such notification

7 shall include a copy of the subpoena or court order;

8 (b) promptly notify in writing the party who caused the subpoena or order

9 to issue in the other litigation that some or all of the material covered by the

10 subpoena or order is subject to this Protective Order. Such notification shall include

11 a copy of this Stipulated Protective Order; and

12 (c) cooperate with respect to all reasonable procedures sought to be

13 pursued by the Designating Party whose Protected Material may be affected.

14 If the Designating Party timely seeks a protective order, the Party served with

15 the subpoena or court order shall not produce any information designated in this

16 action as “CONFIDENTIAL” before a determination by the court from which the

17 subpoena or order issued, unless the Party has obtained the Designating Party’s

18 permission. The Designating Party shall bear the burden and expense of seeking

19 protection in that court of its confidential material and nothing in these provisions

20 should be construed as authorizing or encouraging a Receiving Party in this Action

21 to disobey a lawful directive from another court.

22 9. A NON-PARTY’S PROTECTED MATERIAL SOUGHT TO BE

23 PRODUCED IN THIS LITIGATION

24 (a) The terms of this Order are applicable to information produced by a

25 Non-Party in this Action and designated as “CONFIDENTIAL.” Such information

26 produced by Non-Parties in connection with this litigation is protected by the

27 remedies and relief provided by this Order. Nothing in these provisions should be

1 (b) In the event that a Party is required, by a valid discovery request, to

2 produce a Non-Party’s confidential information in its possession, and the Party is

3 subject to an agreement with the Non-Party not to produce the Non-Party’s

4 confidential information, then the Party shall:

5 (1) promptly notify in writing the Requesting Party and the Non-Party

6 that some or all of the information requested is subject to a confidentiality

7 agreement with a Non-Party;

8 (2) promptly provide the Non-Party with a copy of the Stipulated

9 Protective Order in this Action, the relevant discovery request(s), and a reasonably

10 specific description of the information requested; and

11 (3) make the information requested available for inspection by the

12 Non-Party, if requested.

13 (c) If the Non-Party fails to seek a protective order from this court within

14 14 days of receiving the notice and accompanying information, the Receiving Party

15 may produce the Non-Party’s confidential information responsive to the discovery

16 request. If the Non-Party timely seeks a protective order, the Receiving Party shall

17 not produce any information in its possession or control that is subject to the

18 confidentiality agreement with the Non-Party before a determination by the court.

19 Absent a court order to the contrary, the Non-Party shall bear the burden and

20 expense of seeking protection in this court of its Protected Material.

21 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL

22 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed

23 Protected Material to any person or in any circumstance not authorized under this

24 Stipulated Protective Order, the Receiving Party must immediately (a) notify in

25 writing the Designating Party of the unauthorized disclosures, (b) use its best efforts

26 to retrieve all unauthorized copies of the Protected Material, (c) inform the person or

27 persons to whom unauthorized disclosures were made of all the terms of this Order,

1 Agreement to Be Bound” that is attached hereto as Exhibit A.

2 11. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE

3 PROTECTED MATERIAL

4 When a Producing Party gives notice to Receiving Parties that certain

5 inadvertently produced material is subject to a claim of privilege or other protection,

6 the obligations of the Receiving Parties are those set forth in Federal Rule of Civil

7 Procedure 26(b)(5)(B). This provision is not intended to modify whatever

8 procedure may be established in an e-discovery order that provides for production

9 without prior privilege review. Pursuant to Federal Rule of Evidence 502(d) and

10 (e), insofar as the parties reach an agreement on the effect of disclosure of a

11 communication or information covered by the attorney-client privilege or work

12 product protection, the parties may incorporate their agreement in the stipulated

13 protective order submitted to the court.

14 12. MISCELLANEOUS

15 12.1 Right to Further Relief. Nothing in this Order abridges the right of any

16 person to seek its modification by the Court in the future.

17 12.2 Right to Assert Other Objections. By stipulating to the entry of this

18 Protective Order, no Party waives any right it otherwise would have to object to

19 disclosing or producing any information or item on any ground not addressed in this

20 Stipulated Protective Order. Similarly, no Party waives any right to object on any

21 ground to use in evidence of any of the material covered by this Protective Order.

22 12.3 Filing Protected Material. A Party that seeks to file under seal any

23 Protected Material must comply with Local Civil Rule 79-5. Protected Material

24 may only be filed under seal pursuant to a court order authorizing the sealing of the

25 specific Protected Material at issue. If a Party’s request to file Protected Material

26 under seal is denied by the court, then the Receiving Party may file the information

27 in the public record unless otherwise instructed by the court.

1 13. FINAL DISPOSITION

2 After the final disposition of this Action, as defined in paragraph 4, within 60

3 days of a written request by the Designating Party, each Receiving Party must return

4 all Protected Material to the Producing Party or destroy such material. As used in

5 this subdivision, “all Protected Material” includes all copies, abstracts, compilations,

6 summaries, and any other format reproducing or capturing any of the Protected

7 Material. Whether the Protected Material is returned or destroyed, the Receiving

8 Party must submit a written certification to the Producing Party (and, if not the same

9 person or entity, to the Designating Party) by the 60 day deadline that (1) identifies

10 (by category, where appropriate) all the Protected Material that was returned or

11 destroyed and (2) affirms that the Receiving Party has not retained any copies,

12 abstracts, compilations, summaries or any other format reproducing or capturing any

13 of the Protected Material. Notwithstanding this provision, Counsel are entitled to

14 retain an archival copy of all pleadings, motion papers, trial, deposition, and hearing

15 transcripts, legal memoranda, correspondence, deposition and trial exhibits, expert

16 reports, attorney work product, and consultant and expert work product, even if such

17 materials contain Protected Material. Any such archival copies that contain or

18 constitute Protected Material remain subject to this Protective Order as set forth in

19 Section 4 (DURATION).

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1 || 14. VIOLATION

2 |} Any violation of this Order may be punished by appropriate measures including,

3 || without limitation, contempt proceedings and/or monetary sanctions.

4 || ITIS SO STIPULATED, THROUGH COUNSEL OF RECORD.

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6 || Dated: July 16, 2020 KARIMIAN LAW GROUP

7 By: ___/s/ ShahwS. Karimiaw

SHAHIN S. KARIMIAN, rod.

8 Attorneys for Defendant JOSE MARTINEZ

9 || Dated: July 16, 2020 THE PAYA FIRM

10 By: ___/s/ Briaw Paya □

BRIAN PAYA, PAR

11 Attorneys for Defendant JOSE MARTINEZ

12 || Dated: July 2, 2020 COLLINS COLLINS MUIR & STEWART LLP

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By:___/s/ ThomayAdA. Guterrey

14 THOMAS A. GUTERRES Ese.

Attorneys for Defendants COUNTY OF LOS ANGELES

Dated: July 2, 2020 MICHAEL N. FEUER, Gly Attorney

16 KATHLEEN A. KENEALY, Chief Assist. City Attorney

SCOTT MARCUS, Chief Civil Litigation Branch

17 CORY M. BRENTE, Sr. Assist. City Attorney

ig LISA W. LEE, Deputy City Attorney

By:__/s/ LuaW. Lee

19 LISA W. LEE, De uty Cy Attorne

duromnews for Defendants, CI OF LOS ANGELES

20 CHARLES L. BECK, MICHEL R. MOORE, JERITT

SEVERNS, and LOS ANGELES POLICE

21 DEPARTMENT

22 || FOR GOOD CAUSE SHOWN, IT IS SO ORDERED.

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24 || DATED: July 23, 2020

2s Ups

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GAIL J. STANISH

UNITED STATES MAGISTRATE JUDGE

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1 EXHIBIT A

2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND

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4 I, _____________________________ [print or type full name], of

5 _________________ [print or type full address], declare under penalty of perjury

6 that I have read in its entirety and understand the Stipulated Protective Order that

7 was issued by the United States District Court for the Central District of California

8 on [date] in the case of Jose Martinez v. Charles L. Beck et al, Case No. 2:19-cv-

9 02101-ODW-GJSx. I agree to comply with and to be bound by all the terms of this

10 Stipulated Protective Order and I understand and acknowledge that failure to so

11 comply could expose me to sanctions and punishment in the nature of contempt. I

12 solemnly promise that I will not disclose in any manner any information or item that

13 is subject to this Stipulated Protective Order to any person or entity except in strict

14 compliance with the provisions of this Order.

15 I further agree to submit to the jurisdiction of the United States District Court for the

16 Central District of California for enforcing the terms of this Stipulated Protective

17 Order, even if such enforcement proceedings occur after termination of this action.

18 I hereby appoint __________________________ [print or type full name] of

19 _______________________________________ [print or type full address and

20 telephone number] as my California agent for service of process in connection with

21 this action or any proceedings related to enforcement of this Stipulated Protective

22 Order.

23 Date: ______________________________________

24 City and State where sworn and signed: _________________________________

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26 Printed name: _______________________________

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