A Franchise Registration Forms

Section 200 Section 200.APPENDIX A   Franchise Registration Forms Section 200.ILLUSTRATION G   Certification Page I certify under penalty of law that I have read this notification and the exhibits attached hereto and incorporated herein by reference, and know the contents thereof and that the statements therein are true and correct. Executed at , Illinois , . (SEAL) (Signature(s) of Franchisor, Subfranchisor or Broker) By Title STATE OF ) SS ) COUNTY OF ) Personally appeared before me this day of, the above-named (and) to me known to be the person(s) who executed the foregoing notification (as and respectively, of the above-named applicant) and (each) being first duly sworn, stated upon oath that said notification, and all exhibits submitted herewith, are true and correct. (Notarial Seal) Notary