The opinion
1 EPSTEIN DRANGEL LLP
Danielle S. Futterman, pro hac vice
2
dfutterman@ipcounselors.com
3 60 East 42nd Street, Suite 1250
New York, NY 10165
4 Telephone: 212-292-5390
Facsimile: 212-292-5391
5 NOTE: CHANGES MADE BY THE COURT
Peter J. Farnese (SBN 251204)
6
pfarnese@ipcounselors.com
7 700 South Flower Street, Suite 1000
Los Angeles, California 90017
8 Telephone: 310-356-4668
Facsimile: 310-388-1232
9
10 Attorneys for Plaintiff,
AirDoctor, LLC
11
Jen-Feng Lee, SBN 204328
12 jflee@ltpacificlaw.com
Kenneth K. Tanji, Jr., SBN 162273
13
ktanji@ltpacificlaw.com
14 LT Pacific Law Group, LLP
17800 Castleton Street, #560
15 City of Industry, CA 91748
T: 626-810-7200
16
F: 626-810-7300
17
Attorneys for Defendants
18 Homeburg, Inc.
Replacement-parts
19
UNITED STATES DISTRICT COURT
20
CENTRAL DISTRICT OF CALIFORNIA
21 AIRDOCTOR, LLC.,
CASE NO.: 2:23-cv-00352-DMG
22 Plaintiff,
23
v.
24 STIPULATED PROTECTIVE
HOMEBURG LIMITED, HOMEBURG ORDER
25 INC. and REPLACEMENT-PARTS,
26
Defendants.
27
1 1. PURPOSES AND LIMITATIONS
2 Discovery in this action is likely to involve production of confidential,
3 proprietary, or private information for which special protection from public disclosure
4 and from use for any purpose other than prosecuting this litigation may be warranted.
5 Accordingly, the parties hereby stipulate to and petition the Court to enter the
6 following protective order (“Stipulated Protective Order”). The parties acknowledge
7 that this Stipulated Protective Order does not confer blanket protections on all
8 disclosures or responses to discovery and that the protection it affords from public
9 disclosure and use extends only to the limited information or items that are entitled to
10 confidential treatment under the applicable legal principles. The parties further
11 acknowledge that this Stipulated Protective Order does not authorize any party to file
12 confidential information under seal; Civil Local Rule 79-5 sets forth the procedures
13 that must be followed when a party seeks permission from the court to file material
14 under seal.
15 A. GOOD CAUSE STATEMENT
16 This action is likely to involve trade secrets, customer and pricing lists,
17 financial revenue and profit information, marketing strategies, and other valuable
18 research, development, commercial, financial, technical and/or proprietary
19 information for which special protection from public disclosure and from use for any
20 purpose other than prosecution of this action may be warranted. Such confidential and
21 proprietary materials and information may consist of, among other things,
22 confidential business or financial information, information regarding confidential
23 business practices, or other confidential research, development, or commercial
24 information (including information implicating privacy rights of third parties),
25 information otherwise generally unavailable to the public, or which may be privileged
26 or otherwise protected from disclosure under state or federal statutes, court rules, case
27 decisions, or common law. Accordingly, to expedite the flow of information, to
1 to adequately protect information the Parties are entitled to keep confidential, to
2 ensure that the Parties are permitted reasonable necessary uses of such material in
3 preparation for and in the conduct of trial, to address their handling at the end of the
4 litigation, and serve the ends of justice, a protective order for such information is
5 justified in this matter. It is the intent of the Parties that information will not be
6 designated as confidential for tactical reasons and that nothing be so designated
7 without a good faith belief that it has been maintained in a confidential, non-public
8 manner, and there is good cause why it should not be part of the public record of this
9 case.
10 Additionally, here, there is a need for a two-tiered, attorneys’ eyes only protective
11 order that designates certain material as “HIGHLY CONFIDENTIAL –
12 ATTORNEYS’ EYES ONLY”. See Elements Spirits, Inc. v. Iconic Brands, Inc., Civ.
13 No. CV 15-02692 DDP(AGRx), 2016 WL 2642206, at *1–*2 (C.D. Cal. May 9,
14 2016) (holding that protective order with attorneys’ eyes only designation was
15 warranted to protect party’s confidential information) (citing Nutratech, Inc. v.
16 Syntech Int’l, Inc., 242 F.R.D. 552, 555 (C.D. Cal. 2008); Brown Bag Software v.
17 Symantec Corp., 960 F.2d 1465, 1470 (9th Cir. 1992)). .
18 2. DEFINITIONS
19 2.1 Action: this pending federal lawsuit, AirDoctor, LLC v. Homeburg
20 Limited, et al., Case No. 23-cv-352-DMG-JPR
21 2.2 Challenging Party: a Party (as defined herein) or Non-Party (as defined
22 herein) that challenges the designation of information or items under this Stipulated
23 Protective Order.
24 2.3 “CONFIDENTIAL” Information or Items: information (regardless of
25 how it is generated, stored or maintained) or tangible things that qualify for protection
26 under Federal Rule of Civil Procedure 26(c), as specified in the Good Cause
27 Statement.
1 that is/are extremely confidential and/or sensitive, the disclosure of which to any other
2 Party or Non-Party would create a substantial risk of serious harm, including
3 competitive injury, that could not be avoided by less restrictive means..
4 2.5 Counsel: Outside Counsel of Record and House Counsel (as defined
5 herein) and In-House Counsel (as defined herein), as well as their support staff.
6 2.6 Designating Party: a Party or Non-Party that designates information or
7 items that it produces in disclosures or in responses to discovery as
8 “CONFIDENTIAL” or “CONFIDENTIAL - AEO.”
9 2.7 Disclosure or Discovery Material: all items or information, regardless
10 of the medium or manner in which it is generated, stored, or maintained (including,
11 among other things, testimony, transcripts, and tangible things) that are produced or
12 generated in disclosures or responses to discovery in this matter.
13 2.8 Expert: a person with specialized knowledge or experience in a matter
14 pertinent to the litigation who has been retained by a Party or its counsel to serve as
15 an expert witness or as a consultant in this Action.
16 2.9 In-House Counsel: attorneys who are employees of a party to this
17 Action. In-House Counsel does not include Outside Counsel of Record or any other
18 outside counsel.
19 2.10 Non-Party: any natural person, partnership, corporation, association or
20 other legal entity not named as a Party to this action, including support staff.
21 2.11 Outside Counsel of Record: attorneys who are not employees of a party
22 to this Action but are retained to represent or advise a party to this Action and have
23 appeared in this Action on behalf of that party or are affiliated with a law firm, which
24 has appeared on behalf of that party, including support staff.
25 2.12 Party: any party to this Action, including all of its officers, directors,
26 employees, consultants, retained experts, and Outside Counsel of Record (and their
27 support staffs).
1 Discovery Material in this Action.
2 2.14 Professional Vendors: persons or entities that provide litigation support
3 services (e.g., photocopying, videotaping, translating, preparing exhibits or
4 demonstrations, and organizing, storing, or retrieving data in any form or medium)
5 and their employees and subcontractors.
6 2.15 Protected Material: any Disclosure or Discovery Material that is
7 designated as “CONFIDENTIAL” or “CONFIDENTIAL - AEO.”
8 2.16 Receiving Party: a Party that receives Disclosure or Discovery Material
9 from a Producing Party.
10 3. SCOPE
11 The protections conferred by this Stipulated Protective Order cover not only
12 Protected Material (as defined above), but also (1) any information copied or extracted
13 from Protected Material or information that is otherwise based in whole or in part on
14 Protected Material; (2) all copies, excerpts, summaries, or compilations of Protected
15 Material; and (3) any testimony, conversations, or presentations by Parties or their
16 Counsel that might reveal Protected Material.
17 Any use of Protected Material at trial shall be governed by the orders of the
18 trial judge. This Stipulated Protective Order does not govern the use of Protected
19 Material at trial.
20 4. DURATION
21 Even after final disposition of this litigation, the confidentiality obligations
22 imposed by this Stipulated Protective Order shall remain in effect until a Designating
23 Party agrees otherwise in writing or a court order otherwise directs. Final disposition
24 shall be deemed to be the later of (1) dismissal of all claims and defenses in this
25 Action, with or without prejudice; and (2) final judgment herein after the completion
26 and exhaustion of all appeals, rehearings, remands, trials, or reviews of this Action,
27 including the time limits for filing any motions or applications for extension of time
1 5. DESIGNATING PROTECTED MATERIAL
2 5.1 Exercise of Restraint and Care in Designating Material for Protection.
3 Each Party or Non-Party that designates information or items for protection under this
4 Stipulated Protective Order must take care to limit any such designation to specific
5 material that qualifies under the appropriate standards. The Designating Party must
6 designate for protection only those parts of material, documents, items or oral or
7 written communications that qualify so that other portions of the material, documents,
8 items or communications for which protection is not warranted are not swept
9 unjustifiably within the ambit of this Stipulated Protective Order.
10 Mass, indiscriminate or routinized designations are prohibited. Designations
11 that are shown to be clearly unjustified or that have been made for an improper
12 purpose (e.g., to unnecessarily encumber the case development process or to impose
13 unnecessary expenses and burdens on other parties) may expose the Designating Party
14 to sanctions.
15 If it comes to a Designating Party’s attention that information or items that it
16 designated for protection do not qualify for protection, that Designating Party must
17 promptly notify all other Parties that it is withdrawing the inapplicable designation.
18 5.2 Manner and Timing of Designations. Except as otherwise provided in
19 this Order (see, e.g., second paragraph of section 5.2(a) below), or as otherwise
20 stipulated or ordered, Disclosure or Discovery Material that qualifies for protection
21 under this Stipulated Protective Order must be clearly so designated before the
22 material is disclosed or produced.
23 Designation in conformity with this Order requires:
24 (a) for information in documentary form (e.g., paper or electronic
25 documents, but excluding transcripts of depositions or other pretrial or
26 trial proceedings), that the Producing Party affix at a minimum, the
27 legend “CONFIDENTIAL” or “CONFIDENTIAL - AEO” (hereinafter
1 material. If only a portion or portions of the material on a page qualifies
2 for protection, the Producing Party also must clearly identify the
3 protected portion(s) (e.g., by making appropriate markings in the
4 margins).
5 A Party or Non-Party that makes original documents available for
6 inspection need not designate them for protection until after the
7 inspecting Party has indicated which documents it would like copied and
8 produced. During the inspection and before the designation, all of the
9 material made available for inspection shall be deemed
10 “CONFIDENTIAL.” After the inspecting Party has identified the
11 documents it wants copied and produced, the Producing Party must
12 determine which documents, or portions thereof, qualify for protection
13 under this Order. Then, before producing the specified documents, the
14 Producing Party must affix the Confidential Legend to each page that
15 contains Protected Material. If only a portion of the material on a page
16 qualifies for protection, the Producing Party also must clearly identify
17 the protected portion(s) (e.g., by making appropriate markings in the
18 margins).
19 (b) for testimony given in depositions, that the Designating Party make the
20 designation of Protected Material before the close of the deposition.
21 (c) for information produced in some form other than documentary and for
22 any other tangible items, that the Producing Party affix in a prominent
23 place on the exterior of the container or containers in which the
24 information is stored the Confidential Legend. If only a portion or
25 portions of the information warrants protection, the Producing Party, to
26 the extent practicable, shall identify the protected portion(s).
27 5.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent
1 Designating Party’s right to secure protection under this Stipulated Protective Order
2 for such material. Upon timely correction of a designation, the Receiving Party must
3 make reasonable efforts to assure that the material is treated in accordance with the
4 provisions of this Stipulated Protective Order.
5 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS
6 6.1 Timing of Challenges. Any Party or Non-Party may challenge a
7 designation of Protected Material at any time that is consistent with the Court’s
8 Scheduling Order.
9 6.2 Meet and Confer. The Challenging Party shall initiate the dispute
10 resolution process under Local Rule 37.1 et seq.
11 6.3 The burden of persuasion in any such challenge proceeding shall be on
12 the Designating Party. Frivolous challenges, and those made for an improper purpose
13 (e.g., to harass or impose unnecessary expenses and burdens on other parties) may
14 expose the Challenging Party to sanctions. Unless the Designating Party has waived
15 or withdrawn the confidentiality designation, all parties shall continue to afford the
16 material in question the level of protection to which it is entitled under the Producing
17 Party’s designation until the Court rules on the challenge.
18 7. ACCESS TO AND USE OF PROTECTED MATERIAL
19 7.1 Basic Principles. A Receiving Party may use Protected Material that is
20 disclosed or produced by another Party or by a Non-Party in connection with this
21 Action only for prosecuting, defending or attempting to settle this Action. Such
22 Protected Material may be disclosed only to the categories of persons and under the
23 conditions described in this Stipulated Protective Order. When the Action has been
24 terminated, a Receiving Party must comply with the provisions of section 13 below
25 (FINAL DISPOSITION).
26 Protected Material must be stored and maintained by a Receiving Party at a
27 location and in a secure manner that ensures that access is limited to the persons
1 7.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless
2 otherwise ordered by the Court or permitted in writing by the Designating Party, a
3 Receiving Party may disclose any information or item designated
4 “CONFIDENTIAL” only to:
5 (a) the Receiving Party’s Outside Counsel of Record in this Action, as well
6 as employees of said Outside Counsel of Record to whom it is reasonably
7 necessary to disclose the information for this Action;
8 (b) the officers, directors, and employees (including In-House Counsel) of
9 the Receiving Party to whom disclosure is reasonably necessary for this
10 Action;
11 (c) Experts (as defined in this Order) of the Receiving Party to whom
12 disclosure is reasonably necessary for this Action and who have signed
13 the “Acknowledgment and Agreement to Be Bound” (Exhibit A hereto);
14 (d) the Court and its personnel;
15 (e) Court reporters and their staff;
16 (f) professional jury or trial consultants, mock jurors, and Professional
17 Vendors to whom disclosure is reasonably necessary for this Action and
18 who have signed the “Acknowledgment and Agreement to Be Bound”
19 (Exhibit A hereto);
20 (g) the author or recipient of a document containing the “CONFIDENTIAL”
21 Information or Items ;
22 (h) during their depositions, witnesses, and attorneys for witnesses, in the
23 Action to whom disclosure is reasonably necessary provided: (1) the
24 deposing party requests that the witness sign the “Acknowledgment and
25 Agreement to Be Bound” form attached as Exhibit A hereto; and (2) they
26 will not be permitted to keep any “CONFIDENTIAL” Information or
27 Items unless they sign the “Acknowledgment and Agreement to Be
1 the Designating Party or ordered by the Court. Pages of transcribed
2 deposition testimony or exhibits to depositions that reveal Protected
3 Material may be separately bound by the court reporter and may not be
4 disclosed to anyone except as permitted under this Stipulated Protective
5 Order; and
6 (i) any mediator or settlement officer, and their supporting personnel,
7 mutually agreed upon by any of the parties engaged in settlement
8 discussions or appointed by the Court; and
9 (j) any insurance carrier and/or its representatives to whom disclosure is
10 reasonably necessary, provided that they sign the “Acknowledgment and
11 Agreement to Be Bound” form attached as Exhibit A hereto.
12 7.3 Disclosure of “CONFIDENTIAL - AEO” Information or Items. Unless
13 otherwise ordered by the court or permitted in writing by the Designating Party, a
14 Receiving Party may disclose “CONFIDENTIAL - AEO” Information or Items only
15 to those individuals identified in 7.2(a), (c)-(g) and (i)-(j), except that a Receiving
16 Party may in good faith request that the Designating Party consent in writing to the
17 disclosure of particular material designated “CONFIDENTIAL - AEO” Information
18 or Items to one or more representatives of the Receiving Party to whom disclosure is
19 reasonably necessary for this Action. The Receiving Party may seek leave of court in
20 compliance with Local Rule 37 to designate such representatives if the Receiving
21 Party believes that the Designating Party has unreasonably withheld such consent.
22 Before receiving any “CONFIDENTIAL - AEO” Information or Items, each
23 designated representative shall sign the “Acknowledgment and Agreement to Be
24 Bound” (Exhibit A).
8. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED IN
25
OTHER LITIGATION
26
If a Party is served with a subpoena or a court order issued in other litigation
27
that compels disclosure of any Protected Materials designated in this Action, that
1 Party must:
2 (a) promptly notify in writing the Designating Party. Such notification shall
3 include a copy of the subpoena or court order unless prohibited by law;
4 (b) promptly notify in writing the party who caused the subpoena or order to
5 issue in the other litigation that some or all of the material covered by
6 the subpoena or order is subject to this Stipulated Protective Order. Such
7 notification shall include a copy of this Stipulated Protective Order; and
8 (c) cooperate with respect to all reasonable procedures sought to be pursued
9 by the Designating Party whose Protected Material may be affected.
10 If the Designating Party timely seeks a protective order, the Party served with
11 the subpoena or court order shall not produce any Protected Material before a
12 determination by the court from which the subpoena or order issued, unless the Party
13 has obtained the Designating Party’s permission. The Designating Party shall bear
14 the burden and expense of seeking protection in that court of its Protected Material
15 and nothing in these provisions should be construed as authorizing or encouraging a
16 Receiving Party in this Action to disobey a lawful directive from another court.
17 9. A NON-PARTY’S PROTECTED MATERIAL SOUGHT TO BE PRODUCED
18 IN THIS LITIGATION
(a) The terms of this Stipulated Protective Order are applicable to
19
information produced by a Non-Party in this Action and designated as
20
“CONFIDENTIAL” or “CONFIDENTIAL - AEO.” Such information
21
produced by Non-Parties in connection with this litigation is protected
22
by the remedies and relief provided by this Stipulated Protective Order.
23
Nothing in these provisions should be construed as prohibiting a Non-
24
Party from seeking additional protections.
25
(b) In the event that a Party is required, by a valid discovery request, to
26
produce a Non-Party’s “CONFIDENTIAL” Information or Items in its
27
1 not to produce the Non-Party’s “CONFIDENTIAL” Information or
2 Items, then the Party shall:
3 1) promptly notify in writing the Requesting Party and the Non-Party
4 that some or all of the information requested is subject to a
5 confidentiality agreement with a Non-Party;
6 2) promptly provide the Non-Party with a copy of the Stipulated
7 Protective Order in this Action, the relevant discovery request(s),
8 and a reasonably specific description of the information requested;
9 and
10 3) make the information requested available for inspection by the Non-
11 Party, if requested.
12 (c) If the Non-Party fails to seek a protective order from the relevant court
13 within 14 days of receiving the notice and accompanying information,
14 the Receiving Party may produce the Non-Party’s “CONFIDENTIAL”
15 Information or Items responsive to the discovery request. If the Non-
16 Party timely seeks a protective order, the Receiving Party shall not
17 produce any information in its possession or control that is subject to the
18 confidentiality agreement with the Non-Party before a determination by
19 the court. Absent a court order to the contrary, the Non-Party shall bear
20 the burden and expense of seeking protection in this court of its Protected
21 Material.
22 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL
23 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed
24 Protected Material to any person or in any circumstance not authorized under this
25 Stipulated Protective Order, the Receiving Party must immediately (a) notify in
26 writing the Designating Party of the unauthorized disclosures, (b) use its best efforts
27 to retrieve all unauthorized copies of the Protected Material, (c) inform the person or
1 and (d) request such person or persons to execute the “Acknowledgment and
2 Agreement to Be Bound” that is attached hereto as Exhibit A.
3 11. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE
4 PROTECTED MATERIAL
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 procedure
8
may be established in an e-discovery order that provides for production without prior
9
privilege review. Pursuant to Federal Rule of Evidence 502(d) and (e), insofar as the
10
Parties reach an agreement on the effect of disclosure of a communication or
11
information covered by the attorney-client privilege or work product protection, the
12
Parties may incorporate their agreement in the stipulated protective order submitted
13
to the court provided the Court so allows.
14
12. MISCELLANEOUS
15
12.1 Right to Further Relief. Nothing in this Stipulated Protective Order
16
abridges the right of any 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 Stipulated Protective
22
Order.
23
12.3 Filing Protected Material. A Party that seeks to file under seal any
24
Protected Material must comply with Civil Local Rule 79-5. Protected Material may
25
only be filed under seal pursuant to a Court order authorizing the sealing of the
26
specific Protected Material at issue. If a Party's request to file Protected Material under
27
1 public record unless otherwise instructed by the Court.
2 13. FINAL DISPOSITION
3 After the final disposition of this Action, as defined in paragraph 4, within 60
4 days of a written request by the Designating Party, each Receiving Party must return
5 all Protected Material to the Producing Party or destroy such material. As used in this
6 subdivision, “all Protected Material” includes all copies, abstracts, compilations,
7 summaries, and any other format reproducing or capturing any of the Protected
8 Material. Whether the Protected Material is returned or destroyed, the Receiving
9 Party must submit a written certification to the Producing Party (and, if not the same
10 person or entity, to the Designating Party) by the 60 day deadline that (1) identifies
11 (by category, where appropriate) all the Protected Material that was returned or
12 destroyed and (2) affirms that the Receiving Party has not retained any copies,
13 abstracts, compilations, summaries or any other format reproducing or capturing any
14 of the Protected Material. Notwithstanding this provision, Counsel are entitled to
15 retain an archival copy of all pleadings, motion papers, trial, deposition, and hearing
16 transcripts, legal memoranda, correspondence, deposition and trial exhibits, expert
17 reports, attorney work product, and consultant and expert work product, even if such
18 materials contain Protected Material. Any such archival copies that contain or
19 constitute Protected Material remain subject to this Protective Order as set forth in
20 Section 4 (DURATION).
21 14. Any violation of this Stipulated Protective Order may be punished by any and all
22 appropriate measures including, without limitation, contempt proceedings and/or
23 monetary sanctions.
24 IT IS SO STIPULATED, THROUGH COUNSEL OF RECORD.
25 Respectfully Submitted,
26 DATED: August 29, 2023 EPSTEIN DRANGEL LLP
27
Peter Farnese
1
Danielle Futterman, pro hac vice
2 Attorneys for Plaintiff
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DATED: August 29, 2023 LT PACIFIC LAW GROUP, LLP
6
BY:/s/Jen-Feng Lee
7 Jen-Feng Lee
Kenneth K. Tanji, Jr.
8 LT Pacific Law Group, LLP
Attorneys for Defendants
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2 || FOR GOOD CAUSE SHOWN, IT IS SO ORDERED.
3
‘ fe Rrewhatt~
5 || Dated: August 31, 2023
6 HON. JEAN P. ROSENBLUTH
7 U.S. Magistrate Judge, Central Dist. of California
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1 EXHIBIT A
2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND
3
4 I, _____________________________ [print or type full name], of
5 _________________ [print or type full address], declare under penalty of perjury that
6 I have read in its entirety and understand the Stipulated Protective Order that was
7 issued by the US District Court, Central District of California, on _______________
8 in the case of AIRDOCTOR, LLC v. HOMEBURG LIMITED, HOMEBURG INC;
9 et al., 2:23-cv-00352-DMG-JPR, I agree to comply with and to be bound by all the
10 terms of this Stipulated Protective Order and I understand and acknowledge that
11 failure 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 information
13 or item that is subject to this Stipulated Protective Order to any person or entity except
14 in strict compliance with the provisions of this Order.
15
16 I further agree to submit to the jurisdiction of the US District Court, Central District
17 of California, for enforcing the terms of this Stipulated Protective Order, even if such
18 enforcement proceedings occur after termination of this action. I hereby appoint
19 __________________________ [print or type full name] of
20 _______________________________________ [print or type full address and
21 telephone number] as my California agent for service of process in connection with
22 this action or any proceedings related to enforcement of this Stipulated Protective
23 Order.
24 Date: ______________________________________
25 City and State where sworn and signed: _________________________________
26
27 Printed name: _______________________________