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5 6 7 8 UNITED STATES DISTRICT COURT 9 CENTRAL DISTRICT OF CALIFORNIA 10 LOS ANGELES DIVISION 11 Case No.: 2:19-cv-07154-TJH 12 KOI DESIGN LLC, STIPULATED PROTECTIVE ORDER 13 Plaintiffs, [72] 14 v. 15 A. DOUGLAS MASTROIANNI dba MASTROIANNI LAW FIRM; 16 MARRON LAWYERS, APC; THE BLOOM FIRM, APC; and does, 1 17 through 25, 18 Defendants. 19 MARRON LAWYERS, APC and THE BLOOM FIRM, APC, 20 Third-Party Plaintiffs, 21 v. 22 DON THORNBURGH, an 23 individual, and DON THORNBURGH LAW 24 CORPORATION, a California corporation, 25 Third-Party Defendants. 26 27 1 This Stipulated Protective Order is entered into by and between plaintiff KOI 2 DESIGN LLC, defendants and third-party plaintiffs MARRON LAWYERS, APC 3 (“Marron”) and THE BLOOM FIRM, APC (“Bloom”), and third-party defendants 4 DON THORNBURGH and DON THORNBURGH LAW CORPORATION. 5 Plaintiff, defendants/third-party plaintiffs, and third-party defendants are hereinafter 6 collectively referred to as “the Parties.” 7 1. A. PURPOSES AND LIMITATIONS 8 Discovery in this action is likely to involve production of confidential, 9 proprietary or private information for which special protection from public 10 disclosure and from use for any purpose other than prosecuting this litigation may 11 be warranted. Accordingly, the parties hereby stipulate to and petition the Court to 12 enter the following Stipulated Protective Order. The parties acknowledge that this 13 Order does not confer blanket protection on all disclosures or responses to discovery 14 and that the protection it affords from public disclosures and use extends only to the 15 limited information or items that are entitled to confidential treatment under the 16 applicable legal principles. 17 B. GOOD CAUSE STATEMENT 18 This action is likely to involve trade secrets, customer and pricing lists and 19 other valuable research, development, commercial, financial, technical, personnel 20 and/or proprietary information for which special protection from public disclosure 21 and from use for any purpose other than prosecution of this action may be 22 warranted. Such confidential and proprietary materials and information consist of, 23 among other things, confidential business or financial information, information 24 regarding confidential business practices, or other confidential research, 25 development, or commercial information (including information implicating privacy 26 rights of third parties), information otherwise generally unavailable to the public, or 27 which may be privileged or otherwise protected from disclosure under state or 1 expedite the flow of information, to facilitate the prompt resolution of disputes over 2 confidentiality of discovery materials, to adequately protect information the parties 3 are entitled to keep confidential, to ensure that the parties are permitted reasonable 4 necessary uses of such material in preparation for and in conduct of trial, to address 5 their handling at the end of litigation, and serve the ends of justice, a protective 6 order for such information is justified in this matter. It is the intent of the parties 7 that information will not be designated as confidential for tactical reasons and that 8 nothing be so designated without good faith belief that it has been maintained in a 9 confidential, non-public manner, and there is good cause why is should not be part 10 of the public record of this case. 11 C. ACKNOWLEDGMENT OF PROCEDURE FOR FILING UNDER SEAL 12 The parties further acknowledge, as set forth in Section 12.3, below, that this 13 Stipulated Protective Order does not entitle them to file confidential information 14 under seal; Local Civil Rule 79-5 sets forth the procedures that must be followed 15 and the standards that will be applied when a party seeks permission from the court 16 to file material under seal. 17 There is a strong presumption that the public has a right of access to judicial 18 proceedings and records in civil cases. In connection with non-dispositive motions, 19 good cause must be shown to support a filing under seal. See Kamakana v. City and 20 County of Honolulu,

(9th Cir. 2006), Phillips v. Gen. Motors 21 Corp.,

, 1210-11 (9th Cir. 2002), Makar-Welbon v. Sony Electrics, 22 Inc.,

(E.D. Wis. 1999) (even stipulated protective orders 23 require good cause showing), and a specific showing of good cause or compelling 24 reasons with proper evidentiary support and legal justification, must be made with 25 respect to Protected Material that a party seeks to file under seal. The parties’ mere 26 designation of Disclosure or Discovery Material as CONFIDENTIAL does not— 27 without the submission of competent evidence by declaration, establishing that the 1 material sought to be filed under seal qualifies as confidential, privileged, or 2 otherwise protectable—constitute good cause. 3 Further, if a party requests sealing related to a dispositive motion or trial, then 4 compelling reasons, not only good cause, for the sealing must be shown, and the 5 relief sought shall be narrowly tailored to serve the specific interest to be protected. 6 See Pintos v. Pacific Creditors Ass’n,

(9th Cir. 2010). For 7 each item or type of information, document, or thing sought to be filed or introduced 8 under seal in connection with a dispositive motion or trial, the party seeking 9 protection must articulate compelling reasons, supported by specific facts and legal 10 justification, for the requested sealing order. Again, competent evidence supporting 11 the application to file documents under seal must be provided by declaration. 12 Any document that is not confidential, privileged, or otherwise protectable in 13 its entirety will not be filed under seal if the confidential portions can be redacted. 14 If documents can be redacted, then a redacted version for public viewing, omitting 15 only the confidential, privileged, or otherwise protectable portions of the document, 16 shall be filed. Any application that seeks to file documents under seal in their 17 entirety should include an explanation of why redaction is not feasible. 18 2. DEFINITIONS 19 2.1 Action: Koi Design LLC v. A. Douglas Mastroianni dba Mastroianni 20 Law Firm et al., United States District Court, District of California, Central District, 21 Case No. 2:19-cv-07154-TJH. 22 2.2 Challenging Party: a Party or Non-Party that challenges the designation 23 of information or items under this 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 26 protection under Federal Rule of Civil Procedure 26(c), and as specified above in 27 the Good Cause Statement. 1 2.4 Counsel: Outside Counsel of record and House Counsel (as well as 2 their support staff) 3 2.5 Designating Party: a Party or Non-Party that designates information or 4 items that it produces in disclosures or in responses to discovery as 5 “CONFIDENTIAL.” 6 2.6 Disclosure or Discovery Material: all items or information, regardless 7 of the medium or manner in which it is generated, stored, or maintained (including, 8 among other things, testimony, transcripts, and tangible things), that are produced or 9 generated in disclosures or responses to discovery in this matter. 10 2.7 Expert: a person with specialized knowledge or experience in a matter 11 pertinent to the litigation who has been retained by a Party or its counsel to serve as 12 an expert witness or as a consultant in this Action. 13 2.8 House Counsel: attorneys who are employees of a party to this Action. 14 House Counsel does not include Outside Counsel of Record or any other outside 15 counsel. 16 2.9 Non-Party: any natural person, partnership, corporation, association, or 17 other legal entity not named as a Party to this action. 18 2.10 Outside Counsel of Record: attorneys who are not employees of a 19 party to this Action but are retained to represent or advise a party to this Action and 20 have appeared in this Action on behalf of that party or are affiliated with a law firm 21 which has appeared on behalf of that party, and includes support staff. 22 2.11 Party: any party to this Action, including all of its officers, directors, 23 employees, consultants, retained experts, and Outside Counsel of Record (and their 24 support staffs). 25 2.12 Producing Party: a Party or Non-Party that produces Disclosure or 26 Discovery Material in this Action. 27 2.13 Professional Vendors: persons or entities that provide litigation 1 demonstrations, and organizing, storing, or retrieving data in any form or medium) 2 and their employees and subcontractors. 3 2.14 Protected Material: any Disclosure or Discovery Material that is 4 designated as "CONFIDENTIAL." 5 2.15 Receiving Party: a Party that receives Disclosure or Discovery Material 6 from a Producing Party. 7 3. SCOPE 8 The protections conferred by this Stipulation and Order cover not only 9 Protected Material (as defined above), but also (1) any information copied or 10 extracted from Protected Material; (2) all copies, excerpts, summaries, or 11 compilations of Protected Material; and (3) any testimony, conversations, or 12 presentations by Parties or their Counsel that might reveal Protected Material. 13 Any use of Protected Material at trial shall be governed by the orders of the 14 trial judge. This Order does not govern the use of Protected Material at trial. 15 4. DURATION 16 FINAL DISPOSITION of the action is defined as the conclusion of any 17 appellate proceedings, or, if no appeal is taken, when the time for filing of an appeal 18 has run. Except as set forth below, the terms of this protective order apply through 19 FINAL DISPOSITION of the action. The parties may stipulate that the they will be 20 contractually bound by the terms of this agreement beyond FINAL DISPOSITION, 21 but will have to file a separate action for enforcement of the agreement once all 22 proceedings in this case are complete. 23 Once a case proceeds to trial, information that was designated as 24 CONFIDENTIAL or maintained pursuant to this protective order used or introduced 25 as an exhibit at trial becomes public and will be presumptively available to all 26 members of the public, including the press, unless compelling reasons supported by 27 specific factual findings to proceed otherwise are made to the trial judge in advance 1 showing for sealing documents produced in discovery from “compelling reasons” 2 standard when merits-related documents are part of court record). Accordingly, for 3 such materials, the terms of this protective order do not extend beyond the 4 commencement of trial. 5 5. DESIGNATING PROTECTED MATERIAL 6 5.1 Exercise of Restraint and Care in Designating Material for Protection. 7 Each Party or Non-Party that designates information or items for protection 8 under this Order must take care to limit any such designation to specific material 9 that qualifies under the appropriate standards. The Designating Party must designate 10 for protection only those parts of material, documents, items, or oral or written 11 communications that qualify so that other portions of the material, documents, 12 items, or communications for which protection is not warranted are not swept 13 unjustifiably within the ambit of this Order. 14 Mass, indiscriminate, or routinized designations are prohibited. Designations 15 that are shown to be clearly unjustified or that have been made for an improper 16 purpose (e.g., to unnecessarily encumber the case development process or to impose 17 unnecessary expenses and burdens on other parties) may expose the Designating 18 Party to sanctions. 19 If it comes to a Designating Party's attention that information or items that it 20 designated for protection do not qualify for protection, that Designating Party must 21 promptly notify all other Parties that it is withdrawing the inapplicable designation. 22 5.2 Manner and Timing of Designations. Except as otherwise provided in 23 this Order (see, e.g., second paragraph of section 5.2(a) below), or as otherwise 24 stipulated or ordered, Disclosure or Discovery Material that qualifies for protection 25 under this Order must be clearly so designated before the material is disclosed or 26 produced. 27 Designation in conformity with this Order requires: 1 documents, but excluding transcripts of depositions or other pretrial or trial 2 proceedings), that the Producing Party affix at a minimum, the legend 3 "CONFIDENTIAL" (hereinafter "CONFIDENTIAL legend"), to each page that 4 contains protected material. If only a portion or portions of the material on a page 5 qualifies for protection, the Producing Party also must clearly identify the protected 6 portion(s) (e.g., by making appropriate markings in the margins). 7 A Party or Non-Party that makes original documents available for inspection 8 need not designate them for protection until after the inspecting Party has indicated 9 which documents it would like copied and produced. During the inspection and 10 before the designation, all of the material made available for inspection shall be 11 deemed "CONFIDENTIAL." After the inspecting Party has identified the 12 documents it wants copied and produced, the Producing Party must determine which 13 documents, or portions thereof, qualify for protection under this Order. Then, before 14 producing the specified documents, the Producing Party must affix the 15 "CONFIDENTIAL legend" to each page that contains Protected Material. If only a 16 portion or portions of the material on a page qualifies for protection, the Producing 17 Party also must clearly identify the protected portion(s) (e.g., by making appropriate 18 markings in the margins). 19 (b) for testimony given in depositions that the Designating Party 20 identify the Disclosure or Discovery Material on the record, before the close of the 21 deposition all protected testimony. 22 (c) for information produced in some form other than documentary 23 and for any other tangible items, that the Producing Party affix in a prominent place 24 on the exterior of the container or containers in which the information is stored the 25 legend "CONFIDENTIAL." If only a portion or portions of the information warrants 26 protection, the Producing Party, to the extent practicable, shall identify the protected 27 portion(s). 1 5.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent 2 failure to designate qualified information or items does not, standing alone, waive 3 the Designating Party's right to secure protection under this Order for such material. 4 Upon timely correction of a designation, the Receiving Party must make reasonable 5 efforts to assure that the material is treated in accordance with the provisions of this 6 Order. 7 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS 8 6.1 Timing of Challenges. Any Party or Non-Party may challenge a 9 designation of confidentiality at any time that is consistent with the Court's 10 Scheduling Order. 11 6.2 Meet and Confer. The Challenging Party shall initiate the dispute 12 resolution process under Local Rule 3 7 .1 et seq. 13 6.3 The burden of persuasion in any such challenge proceeding shall be on 14 the Designating Party. Frivolous challenges, and those made for an improper 15 purpose (e.g., to harass or impose unnecessary expenses and burdens on other 16 parties) may expose the Challenging Party to sanctions. Unless the Designating 17 Party has waived or withdrawn the confidentiality designation, all parties shall 18 continue to afford the material in question the level of protection to which it is 19 entitled under the Producing Party's designation until the Court rules on the 20 challenge. 21 7. ACCESS TO AND USE OF PROTECTED MATERIAL 22 7.1 Basic Principles. A Receiving Party may use Protected Material that is 23 disclosed or produced by another Party or by a Non-Party in connection with this 24 Action only. for prosecuting, defending, or attempting to settle this Action. Such 25 Protected Material may be disclosed only to the categories of persons and under the 26 conditions described in this Order. When the Action has been terminated, a 27 Receiving Party must comply with the provisions of section 13 below (FINAL 1 Protected Material must be stored and maintained by a Receiving Party at a 2 location and in a secure manner that ensures that access is limited to the persons 3 authorized under this Order. 4 7.2 Disclosure of "CONFIDENTIAL" Information or Items. Unless 5 otherwise ordered by the court or permitted in writing by the Designating Party, a 6 Receiving Party may disclose any information or item designated 7 "CONFIDENTIAL" only to: 8 (a) the Receiving Party's Outside Counsel of Record in this Action, 9 as well as employees of said Outside Counsel of Record to whom it is reasonably 10 necessary to disclose the information for this Action; 11 (b) the officers, directors, and employees (including House Counsel) 12 of the Receiving Party to whom disclosure is reasonably necessary for this Action; 13 (c) Experts (as defined in this Order) of the Receiving Party to 14 whom disclosure is reasonably necessary for this Action and who have signed the 15 "Acknowledgment and Agreement to Be Bound" (Exhibit A); 16 (d) the court and its personnel; 17 (e) court reporters and their staff; 18 (f) professional jury or trial consultants, mock jurors, and 19 Professional Vendors to whom disclosure is reasonably necessary for this Action 20 and who have signed the "Acknowledgment and Agreement to Be Bound" (Exhibit 21 A); 22 (g) the author or recipient of a document containing the information 23 or a custodian or other person who otherwise possessed or knew the information; 24 (h) during their depositions, witnesses, and attorneys for witnesses, 25 in the Action to whom disclosure is reasonably necessary provided: (1) the deposing 26 party requests that the witness sign the form attached as Exhibit 1 hereto; and (2) 27 they will not be permitted to keep any confidential information unless they sign the 1 agreed by the Designating Party or ordered by the court. Pages of transcribed 2 deposition testimony or exhibits to depositions that reveal Protected Material may 3 be separately bound by the court reporter and may not be disclosed to anyone except 4 as permitted under this Stipulated Protective Order; 5 (i) any mediator or settlement officer, and their supporting 6 personnel, mutually agreed upon by any of the parties engaged in settlement 7 discussions; and 8 (j) any insurers to whom any Receiving Party or its counsel is 9 required to respond or report in the ordinary course of its business regarding this 10 action. 11 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED 12 IN OTHER LITIGATION 13 If a Party is served with a subpoena or a court order issued in other litigation 14 that compels disclosure of any information or items designated in this Action as 15 "CONFIDENTIAL," that Party must: 16 (a) promptly notify in writing the Designating Party. Such 17 notification shall include a copy of the subpoena or court order; 18 (b) promptly notify in writing the party who caused the subpoena or 19 order to issue in the other litigation that some or all of the material covered by the 20 subpoena or order is subject to this Protective Order. Such notification shall include 21 a copy of this Stipulated Protective Order; and 22 (c) cooperate with respect to all reasonable procedures sought to be 23 pursued by the Designating Party whose Protected Material may be affected. 24 If the Designating Party timely seeks a protective order, the Party served with 25 the subpoena or court order shall not produce any information designated in this 26 action as "CONFIDENTIAL" before a determination by the court from which the 27 subpoena or order issued, unless the Party has obtained the Designating Party's 1 protection in that court of its confidential material and nothing in these provisions 2 should be construed as authorizing or encouraging a Receiving Party in this Action 3 to disobey a lawful directive from another court. 4 9. A NON-PARTY'S PROTECTED MATERIAL SOUGHT TO BE 5 PRODUCED IN THIS LITIGATION 6 (a) The terms of this Order are applicable to information produced 7 by a Non-Party in this Action and designated as "CONFIDENTIAL." Such 8 information produced by Non-Parties in connection with this litigation is protected 9 by the remedies and relief provided by this Order. Nothing in these provisions 10 should be construed as prohibiting a Non-Party from seeking additional protections. 11 (b) In the event that a Party is required, by a valid discovery request, 12 to produce a Non-Party's confidential information in its possession, and the Party is 13 subject to an agreement with the Non-Party not to produce the Non-Party's 14 confidential information, then the Party shall: 15 (1) promptly notify in writing the Requesting Party and the Non- 16 Party that some or all of the information requested is subject to a confidentiality 17 agreement with a Non-Party; 18 (2) promptly provide the Non-Party with a copy of the Stipulated 19 Protective Order in this Action, the relevant discovery request(s), and a reasonably 20 specific description of the information requested; and 21 (3) make the information requested available for inspection by the 22 Non-Party, if requested. 23 (c) If the Non-Party fails to seek a protective order from this court 24 within 14 days of receiving the notice and accompanying information, the Receiving 25 Party may produce the Non-Party's confidential information responsive to the 26 discovery request. If the Non-Party timely seeks a protective order, the Receiving 27 Party shall not produce any information in its possession or control that is subject to 1 court. Absent a court order to the contrary, the Non-Party shall bear the burden and 2 expense of seeking protection in this court of its Protected Material. 3 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL 4 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed 5 Protected Material to any person or in any circumstance not authorized under this 6 Stipulated Protective Order, the Receiving Party must immediately (a) notify in 7 writing the Designating Party of the unauthorized disclosures, (b) use its best efforts 8 to retrieve all unauthorized copies of the Protected Material, ( c) inform the person 9 or persons to whom unauthorized disclosures were made of all the terms of this 10 Order, and (d) request such person or persons to execute the "Acknowledgment and 11 Agreement to Be Bound" that is attached hereto as Exhibit A. 12 11. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE 13 PROTECTED MATERIAL 14 When a Producing Party gives notice to Receiving Parties that certain 15 inadvertently produced material is subject to a claim of privilege or other protection, 16 the obligations of the Receiving Parties are those set forth in Federal Rule of Civil 17 Procedure 26(b)(5)(B). This provision is not intended to modify whatever procedure 18 may be established in an e-discovery order that provides for production without 19 prior privilege review. Pursuant to Federal Rule of Evidence 502(d) and (e), insofar 20 as the parties reach an agreement on the effect of disclosure of a communication or 21 information covered by the attorney-client privilege or work product protection, the 22 parties may incorporate their agreement in the stipulated protective order submitted 23 to the court. 24 12. MISCELLANEOUS 25 12.1 Right to Further Relief. Nothing in this Order abridges the right of any 26 person to seek its modification by the Court in the future. 27 12.2 Right to Assert Other Objections. By stipulating to the entry of this 1 disclosing or producing any information or item on any ground not addressed in this 2 Stipulated Protective Order. Similarly, no Party waives any right to object on any 3 ground to use in evidence of any of the material covered by this Protective Order. 4 12.3 Filing Protected Material. A Party that seeks to file under seal any 5 Protected Material must comply with Civil Local Rule 79-5. Protected Material may 6 only be filed under seal pursuant to a court order authorizing the sealing of the 7 specific Protected Material at issue. If a Party's request to file Protected Material 8 under seal is denied by the court, then the Receiving Party may file the information 9 in the public record unless otherwise instructed by the court. 10 13. FINAL DISPOSITION 11 After the final disposition of this Action, as defined in paragraph 4, within 60 12 days of a written request by the Designating Party, each Receiving Party must return 13 all Protected Material to the Producing Party or destroy such material. As used in 14 this subdivision, "all Protected Material" includes all copies, abstracts, compilations, 15 summaries, and any other format reproducing or capturing any of the Protected 16 Material. Whether the Protected Material is returned or destroyed, the Receiving 17 Party must submit a written certification to the Producing Party ( and, if not the 18 same person or entity, to the Designating Party) by the 60 day deadline that (1) 19 identifies (by category, where appropriate) all the Protected Material that was 20 returned or destroyed and (2)affirms that the Receiving Party has not retained any 21 copies, abstracts, compilations, summaries or any other format reproducing or 22 capturing any of the Protected Material. Notwithstanding this provision, Counsel are 23 entitled to retain an archival copy of all pleadings, motion papers, trial, deposition, 24 and hearing transcripts, legal memoranda, correspondence, deposition and trial 25 exhibits, expert reports, attorney work product, and consultant and expert work 26 product, even if such materials contain Protected Material. Any such archival copies 27 that contain or constitute Protected Material remain subject to this Protective Order 1} }14. VIOLATION 2 Any violation of this Order may be punished by any and all appropriate 3 || measures including, without limitation, contempt proceedings and/or monetary 4 || sanctions. 5 6 IS SO STIPULATED, THROUGH COUNSEL OF RECORD. 7 8 || DATED: May 12, 2021 sil Jared V. Walder 9 Ronald W. Makan. Esq. Jared V. W der,/ sq. 10 Attorneys for Plaintiff KOI DESIGN LLC Hy 11 ff / 4 DATED: May 12, 2021 Ly a | pom~ 12 Randall/A. Miller, Esq. Zachary Mayer, Esq. 13 Attorheys fér Defendant and Third-Party Plaintiff 14 MARRON LAWYERS, APC 'S || DATED: May 12, 2021 /s// Heather L. Rosing 16 Heather L. Rosing, Esq. Amara Barbara, Esq. 17 Attorneys for Defendant and Third-Party Plaintiff 18 THE BLOOM FIRM, APC 19 || DATED: May 12, 2021 /s/! James D. Thornburgh James D. Thornburgh, Esq. 20 Attorneys for Third-Party Defendants DON THORNBURGH and DON 21 THORNBURGH LAW CORPORATION 22 23 || FOR GOOD CAUSE SHOWN, IT IS SO ORDERED. 24 __— Me 25 DATED: MAY 13, 2021 f Valier, hat 26 HON. TERRY HATTER, JR., United &tates District Judge 27 28

1 EXHIBIT A 2 3 ACKNOWLEDGMENT AND AGREEMENT TO BEBOUND 4 I, [print or type full name], of 5 [print or type full address], declare under 6 penalty of perjury that I have read in its entirety and understand the Stipulated 7 Protective Order that was issued by the United States Court for the Central District of 8 California on __________________in the case of Koi Design LLC v. A. Douglas 9 Mastroianni dba Mastroianni Law Firm; Marron Lawyers, APC; The Bloom Firm, 10 APC; and Does, 1 through 25, Case No. 2:19-cv-07154-TJH. I agree to comply with 11 and to be bound by all the terms of this Stipulated Protective Order and I understand 12 and acknowledge that failure to so comply could expose me to sanctions and 13 punishment in the nature of contempt. I solemnly promise that I will not disclose in 14 any manner any information or item that is subject to this Stipulated Protective Order 15 to any person or entity except in strict compliance with the provisions of this Order. 16 I further agree to submit to the jurisdiction of the United States District Court 17 for the Central District of California for enforcing the terms of this Stipulated 18 Protective Order, even if such enforcement proceedings occur after termination of this 19 action. I hereby appoint __________________________ [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 Printed name: _______________________________ 27 Signature: __________________________________