distinguishing “good cause” showing for sealing 9 documents produced in discovery from “compelling reasons” standard when merits- 10 related documents are part of court record
How later courts described this case
- distinguishing “good cause” showing for sealing 9 documents produced in discovery from “compelling reasons” standard when merits- 10 related documents are part of court record
- even stipulated protective orders require good 13 cause showing
Written by the judges who cited it.
The opinion
1 BRIAN D. CHASE, ESQ.
bchase@bisnarchase.com
2
TOM G. ANTUNOVICH, ESQ.
3 tantunovich@bisnarchase.com
BISNAR | CHASE LLP
4
1301 Dove Street, Suite 120
5 Newport Beach, California 92660
Telephone: (949) 752-2999/Facsimile: (949) 752-2777
6
Attorneys for Plaintiff
7 CHRISTINA PEÑALOZA
8
Marie B. Maurice, Esq. (SBN 258069)
9 mmaurice@imwlaw.com
Byron M. Purcell, Esq. (SBN 176410)
10
bpurcell@imwlaw.com
11 Michelle Zhang, Esq. (SBN 348359)
mzhang@imwlaw.com
12
IVIE McNEILL WYATT PURCELL & DIGGS
13 A Professional Law Corporation
444 S. Flower Street, Suite 1800
14
Los Angeles, California 90071
15 Telephone: (213) 489-0028/Facsimile: (213) 489-0552
Attorneys for Defendant,
16
HOME DEPOT U.S.A., INC.
17
UNITED STATES DISTRICT COURT
18
19 CENTRAL DISTRICT OF CALIFORNIA
20 CHRISTINA PEÑALOZA, CASE NO.: 8:22-cv-02214-JWH-ADS
21
Plaintiff, STIPULATED PROTECTIVE
22 ORDER
23 vs.
24 HOME DEPOT U.S.A., INC., and
25 DOES 1 through 20,
26 Defendants.
27
1 1. PURPOSES AND LIMITATIONS
2 Discovery in this action is likely to involve production of confidential, proprietary
3 or private information for which special protection from public disclosure and from use
4 for any purpose other than pursuing this litigation may be warranted. Accordingly, the
5 parties hereby stipulate to and petition the Court to enter the following Stipulated
6 Protective Order. The parties acknowledge that this Order does not confer blanket
7 protections on all disclosures or responses to discovery and that the protection it affords
8 from public disclosure and use extends only to the limited information or items that are
9 entitled to confidential treatment under the applicable legal principles.
10 2. GOOD CAUSE STATEMENT
11 This action is likely to involve trade secrets and other proprietary information
12 manifested in training and business practices documents and property ownership and
13 management agreements, which information is the result of valuable and costly research
14 and development undertaken on behalf of Defendant(s) for which special protection from
15 public disclosure and from use for any purpose other than prosecution of this action is
16 warranted. The documents and information may also include and implicate the privacy
17 rights of third parties, information otherwise generally unavailable to the public, or which
18 may be privileged or otherwise protected from disclosure under state or federal statutes,
19 court rules, case decisions, or common law. Accordingly, to expedite the flow of
20 information, to facilitate the prompt resolution of disputes over confidentiality of
21 discovery materials, to adequately protect information the parties are entitled to keep
22 confidential, to ensure that the parties are permitted reasonable necessary uses of such
23 material in preparation for and in the conduct of trial, to address their handling at the end
24 of the litigation, and serve the ends of justice, a protective order for such information is
25 justified in this matter. It is the intent of the parties that information will not be
26 designated as confidential for tactical reasons and that nothing be so designated without a
27 good faith belief that it has been maintained in a confidential, non-public manner, and
1 there is good cause why it should not be part of the public record of this case.
2 3. ACKNOWLEDGMENT OF UNDER SEAL FILING PROCEDURE
3 The parties further acknowledge, as set forth in Section 14.3, below, that this
4 Stipulated Protective Order does not entitle them to file confidential information under
5 seal; Local Civil Rule 79-5 sets forth the procedures that must be followed and the
6 standards that will be applied when a party seeks permission from the court to file
7 material under seal. There is a strong presumption that the public has a right of access to
8 judicial proceedings and records in civil cases. In connection with non-dispositive
9 motions, good cause must be shown to support a filing under seal. See Kamakana v. City
10 and County of Honolulu, 447 F.3d 1172, 1176 (9th Cir. 2006), Phillips v. Gen. Motors
11 Corp., 307 F.3d 1206, 1210-11 (9th Cir. 2002), Makar-Welbon v. Sony Electrics, Inc.,
12 187 F.R.D. 576, 577 (E.D. Wis. 1999) (even stipulated protective orders require good
13 cause showing), and a specific showing of good cause or compelling reasons with proper
14 evidentiary support and legal justification, must be made with respect to Protected
15 Material that a party seeks to file under seal. The parties’ mere designation of Disclosure
16 or Discovery Material as CONFIDENTIAL does not — without the submission of
17 competent evidence by declaration, establishing that the material sought to be filed under
18 seal qualifies as confidential, privileged, or otherwise protectable — constitute good
19 cause.
20 Further, if a party requests sealing related to a dispositive motion or trial, then
21 compelling reasons, not only good cause, for the sealing must be shown, and the relief
22 sought shall be narrowly tailored to serve the specific interest to be protected. See Pintos
23 v. Pacific Creditors Ass’n., 605 F.3d 665, 677-79 (9th Cir. 2010). For each item or type of
24 information, document, or thing sought to be filed or introduced under seal, the party
25 seeking protection must articulate compelling reasons, supported by specific facts and
26 legal justification, for the requested sealing order. Again, competent evidence supporting
27 the application to file documents under seal must be provided by declaration.
1 Any document that is not confidential, privileged, or otherwise protectable in its
2 entirety will not be filed under seal if the confidential portions can be redacted. If
3 documents can be redacted, then a redacted version for public viewing, omitting only the
4 confidential, privileged, or otherwise protectable portions of the document, shall be filed.
5 Any application that seeks to file documents under seal in their entirety should include an
6 explanation of why redaction is not feasible.
7 4. DEFINITIONS
8 4.1 Action: this pending federal lawsuit.
9 4.2 Challenging Party: a Party or Non-Party that challenges the designation of
10 information or items under this Order.
11 4.3 “CONFIDENTIAL” Information or Items: information (regardless of how
12 it is generated, stored or maintained) or tangible things that qualify for protection under
13 Federal Rule of Civil Procedure 26(c), and as specified above in the Good Cause
14 Statement.
15 4.4 Counsel: Outside Counsel of Record and House Counsel (as well as their
16 support staff).
17 4.5 Designating Party: a Party or Non-Party that designates information or
18 items that it produces in disclosures or in responses to discovery as “CONFIDENTIAL.”
19 4.6 Disclosure or Discovery Material: all items or information, regardless of
20 the medium or manner in which it is generated, stored, or maintained (including, among
21 other things, testimony, transcripts, and tangible things), that are produced or generated in
22 disclosures or responses to discovery.
23 4.7 Expert: a person with specialized knowledge or experience in a matter
24 pertinent to the litigation who has been retained by a Party or its counsel to serve as an
25 expert witness or as a consultant in this Action.
26 4.8 House Counsel: attorneys who are employees of a party to this Action.
27 House Counsel does not include Outside Counsel of Record or any other outside counsel.
1 4.9 Non-Party: any natural person, partnership, corporation, association or
2 other legal entity not named as a Party to this action.
3 4.10 Outside Counsel of Record: attorneys who are not employees of a party to
4 this Action but are retained to represent a party to this Action and have appeared in this
5 Action on behalf of that party or are affiliated with a law firm that has appeared on behalf
6 of that party, and includes support staff.
7 4.11 Party: any party to this Action, including all of its officers, directors,
8 employees, consultants, retained experts, and Outside Counsel of Record (and their
9 support staffs).
10 4.12 Producing Party: a Party or Non-Party that produces Disclosure or
11 Discovery Material in this Action.
12 4.13 Professional Vendors: persons or entities that provide litigation support
13 services (e.g., photocopying, videotaping, translating, preparing exhibits or
14 demonstrations, and organizing, storing, or retrieving data in any form or medium) and
15 their employees and subcontractors.
16 4.14 Protected Material: any Disclosure or Discovery Material that is designated
17 as “CONFIDENTIAL.”
18 4.15 Receiving Party: a Party that receives Disclosure or Discovery
19 Material from a Producing Party.
20 5. SCOPE
21 The protections conferred by this Stipulation and Order cover not only Protected
22 Material (as defined above), but also (1) any information copied or extracted from
23 Protected Material; (2) all copies, excerpts, summaries, or compilations of Protected
24 Material; and (3) any testimony, conversations, or presentations by Parties or their
25 Counsel that might reveal Protected Material.
26 Any use of Protected Material at trial shall be governed by the orders of the trial
27 judge and other applicable authorities. This Order does not govern the use of Protected
1 Material at trial.
2 6. DURATION
3 Once a case proceeds to trial, information that was designated as
4 CONFIDENTIAL or maintained pursuant to this protective order used or introduced as
5 an exhibit at trial becomes public and will be presumptively available to all members of
6 the public, including the press, unless compelling reasons supported by specific factual
7 findings to proceed otherwise are made to the trial judge in advance of the trial. See
8 Kamakana, 447 F.3d at 1180-81 (distinguishing “good cause” showing for sealing
9 documents produced in discovery from “compelling reasons” standard when merits-
10 related documents are part of court record). Accordingly, the terms of this protective
11 order do not extend beyond the commencement of the trial.
12 7. DESIGNATING PROTECTED MATERIAL
13 7.1 Exercise of Restraint and Care in Designating Material for Protection. Each
14 Party or Non-Party that designates information or items for protection under this Order
15 must take care to limit any such designation to specific material that qualifies under the
16 appropriate standards. The Designating Party must designate for protection only those
17 parts of material, documents, items or oral or written communications that qualify so that
18 other portions of the material, documents, items or communications for which protection
19 is not warranted are not swept unjustifiably within the ambit of this Order.
20 Mass, indiscriminate or routinized designations are prohibited. Designations that
21 are shown to be clearly unjustified or that have been made for an improper purpose (e.g.,
22 to unnecessarily encumber the case development process or to impose unnecessary
23 expenses and burdens on other parties) may expose the Designating Party to sanctions.
24 If it comes to a Designating Party’s attention that information or items that it
25 designated for protection do not qualify for protection, that Designating Party must
26 promptly notify all other Parties that it is withdrawing the inapplicable designation.
27
1 7.2 Manner and Timing of Designations. Except as otherwise provided in this
2 Order, or as otherwise stipulated or ordered, Disclosure of Discovery Material that
3 qualifies for protection under this Order must be clearly so designated before the material
4 is disclosed or produced.
5 Designation in conformity with this Order requires:
6 (a) for information in documentary form (e.g., paper or electronic
7 documents, but excluding transcripts of depositions or other pretrial or trial proceedings),
8 that the Producing Party affix at a minimum, the legend “CONFIDENTIAL” (hereinafter
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 must
11 clearly identify the protected portion(s) (e.g., by making appropriate markings in the
12 margins).
13 A Party or Non-Party that makes original documents available for
14 inspection need not designate them for protection until after the inspecting Party has
15 indicated which documents it would like copied and produced. During the inspection and
16 before the designation, all of the material made available for inspection shall be deemed
17 “CONFIDENTIAL.” After the inspecting Party has identified the documents it wants
18 copied and produced, the Producing Party must determine which documents, or portions
19 thereof, qualify for protection under this Order. Then, before producing the specified
20 documents, the Producing Party must affix the “CONFIDENTIAL legend” to each page
21 that contains Protected Material. If only a portion of the material on a page qualifies for
22 protection, the Producing Party also must clearly identify the protected portion(s) (e.g.,
23 by making appropriate markings in the margins).
24 (b) for testimony given in depositions that the Designating Party
25 identifies the Disclosure or Discovery Material on the record, before the close of the
26 deposition all protected testimony.
27 (c) for information produced in some form other than documentary and
1 for any other tangible items, that the Producing Party affix in a prominent place on the
2 exterior of the container or containers in which the information is stored the legend
3 “CONFIDENTIAL.” If only a portion or portions of the information warrants protection,
4 the Producing Party, to the extent practicable, shall identify the protected portion(s).
5 7.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent failure
6 to designate qualified information or items does not, standing alone, waive the
7 Designating Party’s right to secure protection under this Order for such material. Upon
8 timely correction of a designation, the Receiving Party must make reasonable efforts to
9 assure that the material is treated in accordance with the provisions of this Order.
10 8. CHALLENGING CONFIDENTIALITY DESIGNATIONS
11 8.1. Timing of Challenges. Any Party or Non-Party may challenge a designation
12 of confidentiality at any time that is consistent with the Court’s Scheduling Order.
13 8.2 Meet and Confer. The Challenging Party shall initiate the dispute resolution
14 process under Local Rule 37-1 et seq.
15 8.3 Joint Stipulation. Any challenge submitted to the Court shall be via a
16 joint stipulation pursuant to Local Rule 37-2.
17 8.4 The burden of persuasion in any such challenge proceeding shall be on the
18 Designating Party. Frivolous challenges, and those made for an improper purpose (e.g., to
19 harass or impose unnecessary expenses and burdens on other parties) may expose the
20 Challenging Party to sanctions. Unless the Designating Party has waived or withdrawn
21 the confidentiality designation, all parties shall continue to afford the material in question
22 the level of protection to which it is entitled under the Producing Party’s designation until
23 the Court rules on the challenge.
24 9. ACCESS TO AND USE OF PROTECTED MATERIAL
25 9.1 Basic Principles. A Receiving Party may use Protected Material that is
26 disclosed or produced by another Party or by a Non-Party in connection with this Action
27 only for prosecuting, defending or attempting to settle this Action. Such Protected
1 Material may be disclosed only to the categories of persons and under the conditions
2 described in this Order. When the Action has been terminated, a Receiving Party must
3 comply with the provisions of section below (FINAL DISPOSITION).
4 Protected Material must be stored and maintained by a Receiving Party at a
5 location and in a secure manner that ensures that access is limited to the persons
6 authorized under this Order.
7 9.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless otherwise
8 ordered by the court or permitted in writing by the Designating Party, a Receiving Party
9 may disclose any information or item designated “CONFIDENTIAL” only to:
10 (a) the Receiving Party’s Outside Counsel of Record in this Action, as well
11 as employees of said Outside Counsel of Record to whom it is reasonably necessary to
12 disclose the information for this Action;
13 (b) the officers, directors, and employees (including House Counsel) of the
14 Receiving Party to whom disclosure is reasonably necessary for this Action;
15 (c) Experts (as defined in this Order) of the Receiving Party to whom
16 disclosure is reasonably necessary for this Action and who have signed the
17 “Acknowledgment and Agreement to Be Bound” (Exhibit A);
18 (d) the court and its personnel;
19 (e) court reporters and their staff;
20 (f) professional jury or trial consultants, mock jurors, and Professional
21 Vendors to whom disclosure is reasonably necessary for this Action and who have signed
22 the “Acknowledgment and Agreement to Be Bound” (Exhibit A);
23 (g) the author or recipient of a document containing the information or a
24 custodian or other person who otherwise possessed or knew the information;
25 (h) during their depositions, witnesses, and attorneys for witnesses, in the
26 Action to whom disclosure is reasonably necessary provided: (1) the deposing party
27 requests that the witness sign the form attached as Exhibit A hereto; and (2) they will not
1 be permitted to keep any confidential information unless they sign the “Acknowledgment
2 and Agreement to Be Bound” (Exhibit A), unless otherwise agreed by the Designating
3 Party or ordered by the court. Pages of transcribed deposition testimony or exhibits to
4 depositions that reveal Protected Material may be separately bound by the court reporter
5 and may not be disclosed to anyone except as permitted under this Stipulated Protective
6 Order; and
7 (i) any mediators or settlement officers and their supporting personnel,
8 mutually agreed upon by any of the parties engaged in settlement discussions.
9 10. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED
10 IN OTHER LITIGATION
11 If a Party is served with a subpoena or a court order issued in other litigation that
12 compels disclosure of any information or items designated in this Action as
13 “CONFIDENTIAL,” that Party must:
14 (a) promptly notify in writing the Designating Party. Such notification shall
15 include a copy of the subpoena or court order;
16 (b) promptly notify in writing the party who caused the subpoena or order
17 to issue in the other litigation that some or all of the material covered by the subpoena or
18 order is subject to this Protective Order. Such notification shall include a copy of this
19 Stipulated Protective Order; and
20 (c) cooperate with respect to all reasonable procedures sought to be pursued
21 by the Designating Party whose Protected Material may be affected. If the Designating
22 Party timely seeks a protective order, the Party served with the subpoena or court order
23 shall not produce any information designated in this action as “CONFIDENTIAL” before
24 a determination by the court from which the subpoena or order issued, unless the Party
25 has obtained the Designating Party’s permission. The Designating Party shall bear the
26 burden and expense of seeking protection in that court of its confidential material and
27 nothing in these provisions should be construed as authorizing or encouraging a
1 Receiving Party in this Action to disobey a lawful directive from another court.
2 11. A NON-PARTY’S PROTECTED MATERIAL SOUGHT TO BE
3 PRODUCED IN THIS LITIGATION
4 (a) The terms of this Order are applicable to information produced by a
5 Non-Party in this Action and designated as “CONFIDENTIAL.” Such information
6 produced by Non-Parties in connection with this litigation is protected by the remedies
7 and relief provided by this Order. Nothing in these provisions should be construed as
8 prohibiting a Non-Party from seeking additional protections.
9 (b) In the event that a Party is required, by a valid discovery request, to
10 produce a Non-Party’s confidential information in its possession, and the Party is subject
11 to an agreement with the Non-Party not to produce the Non-Party’s confidential
12 information, then the Party shall:
13 (1) promptly notify in writing the Requesting Party and the Non-Party that
14 some or all of the information requested is subject to a confidentiality agreement with a
15 Non-Party;
16 (2) promptly provide the Non-Party with a copy of the Stipulated Protective
17 Order in this Action, the relevant discovery request(s), and a reasonably specific
18 description of the information requested; and
19 (3) make the information requested available for inspection by the Non-
20 Party, if requested.
21 (c) If the Non-Party fails to seek a protective order from this court within
22 14 days of receiving the notice and accompanying information, the Receiving Party may
23 produce the Non-Party’s confidential information responsive to the discovery request. If
24 the Non-Party timely seeks a protective order, the Receiving Party shall not produce any
25 information in its possession or control that is subject to the confidentiality agreement
26 with the Non-Party before a determination by the court. Absent a court order to the
27 contrary, the Non-Party shall bear the burden and expense of seeking protection in this
1 court of its Protected Material.
2 12. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL
3 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed
4 Protected Material to any person or in any circumstance not authorized under this
5 Stipulated Protective Order, the Receiving Party must immediately (a) notify in writing
6 the Designating Party of the unauthorized disclosures, (b) use its best efforts to retrieve
7 all unauthorized copies of the Protected Material, (c) inform the person or persons to
8 whom unauthorized disclosures were made of all the terms of this Order, and (d) request
9 such person or persons to execute the “Acknowledgment an Agreement to Be
10 Bound” attached hereto as Exhibit A.
11 13. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE
12 PROTECTED MATERIAL
13 When a Producing Party gives notice to Receiving Parties that certain
14 inadvertently produced material is subject to a claim of privilege or other protection, the
15 obligations of the Receiving Parties are those set forth in Federal Rule of Civil Procedure
16 26(b)(5)(B). This provision is not intended to modify whatever procedure may be
17 established in an e-discovery order that provides for production without prior privilege
18 review. Pursuant to Federal Rule of Evidence 502(d) and (e), insofar as the parties reach
19 an agreement on the effect of disclosure of a communication or information covered by
20 the attorney-client privilege or work product protection, the parties may incorporate their
21 agreement in the stipulated protective order submitted to the court.
22 14. MISCELLANEOUS
23 14.1 Right to Further Relief. Nothing in this Order abridges the right of any
24 person to seek its modification by the Court in the future.
25 14.2 Right to Assert Other Objections. By stipulating to the entry of this
26 Protective Order, no Party waives any right it otherwise would have to object to
27 disclosing or producing any information or item on any ground not addressed in this
1 Stipulated Protective Order. Similarly, no Party waives any right to object on any ground
2 to use in evidence of any of the material covered by this Protective Order.
3 14.3 Filing Protected Material. A Party that seeks to file under seal any
4 Protected Material must comply with Local Civil Rule 79-5. Protected Material may only
5 be filed under seal pursuant to a court order authorizing the sealing of the specific
6 Protected Material. If a Party’s request to file Protected Material under seal is denied by
7 the court, then the Receiving Party may file the information in the public record unless
8 otherwise instructed by the court.
9 15. FINAL DISPOSITION
10 After the final disposition of this Action, as defined in paragraph 6, within 60 days
11 of a written request by the Designating Party, each Receiving Party must return all
12 Protected Material to the Producing Party or destroy such material. As used in this
13 subdivision, “all Protected Material” includes all copies, abstracts, compilations,
14 summaries, and any other format reproducing or capturing any of the Protected Material.
15 Whether the Protected Material is returned or destroyed, the Receiving Party must submit
16 a written certification to the Producing Party (and, if not the same person or entity, to the
17 Designating Party) by the 60-day deadline that (1) identifies (by category, where
18 appropriate) all the Protected Material that was returned or destroyed and (2) affirms that
19 the Receiving Party has not retained any copies, abstracts, compilations, summaries or
20 any other format reproducing or capturing any of the Protected Material. Notwithstanding
21 this provision, Counsel are entitled to retain an archival copy of all pleadings, motion
22 papers, trial, deposition, and hearing transcripts, legal memoranda, correspondence,
23 deposition and trial exhibits, expert reports, attorney work product, and consultant and
24 expert work product, even if such materials contain Protected Material. Any such archival
25 copies that contain or constitute Protected Material remain subject to this Protective
26 Order as set forth in Section 6 (DURATION).
27
1 16. VIOLATION
2 Any violation of this Order may be punished by appropriate measures including,
3 without limitation, contempt proceedings and/or monetary sanctions.
4 IT IS SO STIPULATED, THROUGH COUNSEL OF RECORD.
5
DATED: March 24, 2023 BISNAR | CHASE LLP
6
7
By: /s/TOM G. ANTUNOVICH
8
BRIAN D. CHASE, ESQ.
9 TOM G. ANTUNOVICH, ESQ
Attorneys for Plaintiff
10
CHRISTINA PEÑALOZA
11
DATED: March 24, 2023 IVIE McNEILL WYATT
12
PURCELL & DIGGS
13
By: /S/ MARIE MAURICE
14
MARIE B. MAURICE, ESQ.
15 BYRON M. PURCELL, ESQ.
MICHELLE ZHANG, ESQ.
16
Attorneys for Defendant
17 HOME DEPOT U.S.A., INC.
18
19 Upon consideration of the parties’ Stipulation for Protective Order and for
20 good cause shown, it is hereby ORDERED that the Order is granted.
21
22
DATED: 3/29/2023 /s/ Autumn D. Spaeth
23
HONORABLE AUTUMN D. SPAETH
24 United States Magistrate Judge
25
26
27
1 EXHIBIT A
2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND
3 I, (name) of
4
5 (address) declare under penalty of perjury that I have read in its entirety and
6 understand the Stipulated Protective Order that was issued by the United States
7 District Court for the Central District of California on the ___ day of ________,
8 2023, in the case of Christina Peñaloza v. Home Depot U.S.A., Inc, Case No.
9 8:22-cv-02214-JWH-ADS. I agree to comply with and to be bound by all the terms
10 of this Stipulated Protective Order and I understand and acknowledge that failure
11 to so comply could expose me to sanctions and punishment in the nature of
12 contempt. I solemnly promise that I will not disclose in any manner any
13 information or item that is subject to this Stipulated Protective Order to any person
14 or entity except in strict compliance with the provisions of this Order.
15 I further agree to submit to the jurisdiction of the United States District Court
16 for the Central District of California for the purpose of enforcing the terms of this
17 Stipulated Protective Order, even if such enforcement proceedings occur after
18 termination of this action.
19 I hereby appoint [full name]
20 of
21 [full address and telephone number] as my
22 California agent for service of process in connection with this action or any
23 proceedings related to enforcement of this Stipulated Protective Order.
24
25 Date: Signature:
26
27 City and State where sworn and signed: