IN WITNESS WHEREOF
            James A. Steele and {name} have duly affixed their signatures on this {input10:4} day of {input10:5}, {input10:6}.
             
            Information Provider 
             
            
             
             
            James A. Steele
            UNIT 204, 112 14TH Ave SE
            Calgary, Alberta, Canada, T2G 1C7
             
             
            WITNESS: signature
            Coral P. Francis
            WITNESS: printed name: