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2025 ANNUAL MEETINg
MAY 21, 2025

Nominee:
Name:
Address:
Home/Cell Phone Number:
Email:

PERTINENT BIOGRAPHICAL INFORMATION AND QUALIFICATIONS

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

April 16, 2025 4:13 pm EDT

Woodbury Park POA - 2025 Annual Meeting_Candidate Application Uploaded by Community Support Services East - [email protected] IP 96.230.109.26

April 16, 2025 4:18 pm EDT

CSS East - [email protected] added by Community Support Services East - [email protected] as a CC'd Recipient Ip: 96.230.109.26