%PDF-1.6
%
1 0 obj
<<
/AcroForm 2 0 R
/Metadata 3 0 R
/Pages 4 0 R
/Perms <<
/UR3 <<
/ByteRange [0 1089 12891 157165]
/Contents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
/Filter /Adobe.PPKLite
/M (D:20190529161508-05'00')
/Name (ARE Acrobat Product v8.0 P23 0002337)
/Prop_Build <<
/App <<
/Name /Acrobat#20Pro#20DC
/OS [/Mac]
/R 1248256
/REx (2019.012.20034)
/TrustedMode true
>>
/Filter <<
/Date (May 3 2019 02:05:53)
/Name /Adobe.PPKLite
/R 131104
/V 2
>>
/PubSec <<
/Date (May 3 2019 02:05:53)
/NonEFontNoWarn true
/R 131105
>>
>>
/Reference [5 0 R]
/SubFilter /adbe.pkcs7.detached
/Type /Sig
>>
>>
/Type /Catalog
>>
endobj
6 0 obj
<<
>>
endobj
2 0 obj
<<
/DA (/Helv 0 Tf 0 g )
/DR <<
/Encoding <<
/PDFDocEncoding 7 0 R
>>
/Font <<
/Helv 8 0 R
/ZaDb 9 0 R
>>
>>
/Fields [10 0 R 11 0 R 12 0 R 13 0 R 14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R
20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R
30 0 R 31 0 R]
/SigFlags 2
>>
endobj
3 0 obj
<<
/Length 3551
/Subtype /XML
/Type /Metadata
>>
stream
2019-05-24T20:39:04Z
Word
2019-05-29T16:15:08-05:00
2019-05-29T16:15:08-05:00
macOS Version 10.14.3 (Build 18D109) Quartz PDFContext
application/pdf
Microsoft Word - S1004-OverAgeDependant.docx
1
1.1
uuid:4c23dc6f-b5b4-af41-ba97-416bffce1af7
uuid:e4f0ad09-d9b0-5c47-958b-6587afb3d354
endstream
endobj
4 0 obj
<<
/Count 1
/Kids [32 0 R]
/Type /Pages
>>
endobj
5 0 obj
<<
/Data 1 0 R
/TransformMethod /UR3
/TransformParams <<
/Annots [/Create /Delete /Modify /Copy /Import /Export]
/Document [/FullSave]
/Form [/Add /FillIn /Delete /SubmitStandalone]
/Signature [/Modify]
/Type /TransformParams
/V /2.2
>>
/Type /SigRef
>>
endobj
7 0 obj
<<
/Differences [24 /breve /caron /circumflex /dotaccent /hungarumlaut /ogonek /ring /tilde 39
/quotesingle 96 /grave 128 /bullet /dagger /daggerdbl /ellipsis /emdash /endash
/florin /fraction /guilsinglleft /guilsinglright /minus /perthousand /quotedblbase /quotedblleft /quotedblright /quoteleft
/quoteright /quotesinglbase /trademark /fi /fl /Lslash /OE /Scaron /Ydieresis /Zcaron
/dotlessi /lslash /oe /scaron /zcaron 160 /Euro 164 /currency 166
/brokenbar 168 /dieresis /copyright /ordfeminine 172 /logicalnot /.notdef /registered /macron
/degree /plusminus /twosuperior /threesuperior /acute /mu 183 /periodcentered /cedilla /onesuperior
/ordmasculine 188 /onequarter /onehalf /threequarters 192 /Agrave /Aacute /Acircumflex /Atilde
/Adieresis /Aring /AE /Ccedilla /Egrave /Eacute /Ecircumflex /Edieresis /Igrave /Iacute
/Icircumflex /Idieresis /Eth /Ntilde /Ograve /Oacute /Ocircumflex /Otilde /Odieresis /multiply
/Oslash /Ugrave /Uacute /Ucircumflex /Udieresis /Yacute /Thorn /germandbls /agrave /aacute
/acircumflex /atilde /adieresis /aring /ae /ccedilla /egrave /eacute /ecircumflex /edieresis
/igrave /iacute /icircumflex /idieresis /eth /ntilde /ograve /oacute /ocircumflex /otilde
/odieresis /divide /oslash /ugrave /uacute /ucircumflex /udieresis /yacute /thorn /ydieresis]
/Type /Encoding
>>
endobj
8 0 obj
<<
/BaseFont /Helvetica
/Encoding 7 0 R
/Name /Helv
/Subtype /Type1
/Type /Font
>>
endobj
9 0 obj
<<
/BaseFont /ZapfDingbats
/Name /ZaDb
/Subtype /Type1
/Type /Font
>>
endobj
10 0 obj
<<
/AP <<
/N 33 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [187.92 618 363 638.88]
/Subtype /Widget
/T (Last)
/TU (Last)
/Type /Annot
>>
endobj
11 0 obj
<<
/AP <<
/N 36 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [389.52 618 557.16 638.88]
/Subtype /Widget
/T (First)
/TU (First)
/Type /Annot
>>
endobj
12 0 obj
<<
/AP <<
/N 37 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [233.4 595.92 557.16 616.8]
/Subtype /Widget
/T (DDMMYYYY)
/TU (DD/MM/YYYY)
/Type /Annot
>>
endobj
13 0 obj
<<
/AP <<
/N 38 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [113.76 573.6 209.4 594.72]
/Subtype /Widget
/T (Group plan)
/TU (Group plan #:)
/Type /Annot
>>
endobj
14 0 obj
<<
/AP <<
/N 39 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [257.76 573.6 363.96 594.72]
/Subtype /Widget
/T (Firm)
/TU (Firm #:)
/Type /Annot
>>
endobj
15 0 obj
<<
/AP <<
/N 40 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [433.2 573.6 557.16 594.72]
/Subtype /Widget
/T (Firm name)
/TU (Firm name:)
/Type /Annot
>>
endobj
16 0 obj
<<
/AP <<
/N 41 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [365.76 551.52 557.16 572.4]
/Subtype /Widget
/T (Plan member name)
/TU (Plan member name:)
/Type /Annot
>>
endobj
17 0 obj
<<
/AP <<
/N 42 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [306.72 477.36 484.32 498.6]
/Subtype /Widget
/T (undefined)
/TU (undefined)
/Type /Annot
>>
endobj
18 0 obj
<<
/AP <<
/N 43 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [306.36 390 483.84 411.24]
/Subtype /Widget
/T (1)
/TU ([1])
/Type /Annot
>>
endobj
19 0 obj
<<
/AP <<
/N 44 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [306.36 368.4 483.84 389.64]
/Subtype /Widget
/T (2)
/TU ([2])
/Type /Annot
>>
endobj
20 0 obj
<<
/AP <<
/N 45 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [432.24 346.8 485.04 368.04]
/Subtype /Widget
/T (To)
/TU (To)
/Type /Annot
>>
endobj
21 0 obj
<<
/AP <<
/N 46 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [341.64 346.8 394.32 368.04]
/Subtype /Widget
/T (From 1)
/TU (From [1])
/Type /Annot
>>
endobj
22 0 obj
<<
/AP <<
/N 47 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [306.72 324.48 484.32 344.28]
/Subtype /Widget
/T (From 2)
/TU (From [2])
/Type /Annot
>>
endobj
23 0 obj
<<
/AP <<
/N 48 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [140.76 107.28 364.08 133.08]
/Subtype /Widget
/T (Plan member signature)
/TU (Plan member signature)
/Type /Annot
>>
endobj
24 0 obj
<<
/AP <<
/N 49 0 R
>>
/DA (/Helv 0 Tf 0 g)
/DR <<
/Encoding <<
/PDFDocEncoding 34 0 R
>>
/Font <<
/Helv 35 0 R
>>
>>
/F 4
/FT /Tx
/P 32 0 R
/Rect [466.2 107.28 566.4 133.08]
/Subtype /Widget
/T (Date signed)
/TU (Date signed)
/Type /Annot
>>
endobj
25 0 obj
<<
/DA (/Helv 12 Tf 0 g)
/F 4
/FT /Tx
/MK <<
>>
/P 32 0 R
/Rect [113.237 551.126 257.892 572.726]
/Subtype /Widget
/T (Text5)
/Type /Annot
>>
endobj
26 0 obj
<<
/AP <<
/D <<
/Off 50 0 R
/Yes 51 0 R
>>
/N <<
/Off 52 0 R
/Yes 53 0 R
>>
>>
/AS /Off
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 32 0 R
/Rect [306.654 509.237 314.509 516.109]
/Subtype /Widget
/T (Check Box6)
/Type /Annot
>>
endobj
27 0 obj
<<
/AP <<
/D <<
/Off 54 0 R
/Yes 55 0 R
>>
/N <<
/Off 56 0 R
/Yes 57 0 R
>>
>>
/AS /Off
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 32 0 R
/Rect [346.582 509.564 354.436 516.437]
/Subtype /Widget
/T (Check Box7)
/Type /Annot
>>
endobj
28 0 obj
<<
/AP <<
/D <<
/Off 58 0 R
/Yes 59 0 R
>>
/N <<
/Off 60 0 R
/Yes 61 0 R
>>
>>
/AS /Off
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 32 0 R
/Rect [306.654 444.109 314.182 451.309]
/Subtype /Widget
/T (Check Box8)
/Type /Annot
>>
endobj
29 0 obj
<<
/AP <<
/D <<
/Off 62 0 R
/Yes 63 0 R
>>
/N <<
/Off 64 0 R
/Yes 65 0 R
>>
>>
/AS /Off
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 32 0 R
/Rect [345.927 443.782 353.782 450.655]
/Subtype /Widget
/T (Check Box9)
/Type /Annot
>>
endobj
30 0 obj
<<
/AP <<
/D <<
/Off 66 0 R
/Yes 67 0 R
>>
/N <<
/Off 68 0 R
/Yes 69 0 R
>>
>>
/AS /Off
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 32 0 R
/Rect [307.309 302.728 313.854 309.273]
/Subtype /Widget
/T (Check Box10)
/Type /Annot
>>
endobj
31 0 obj
<<
/AP <<
/D <<
/Off 70 0 R
/Yes 71 0 R
>>
/N <<
/Off 72 0 R
/Yes 73 0 R
>>
>>
/AS /Off
/F 4
/FT /Btn
/MK <<
/BC [0.0]
/BG [1.0]
>>
/P 32 0 R
/Rect [345.927 302.728 354.109 308.946]
/Subtype /Widget
/T (Check Box11)
/Type /Annot
>>
endobj
32 0 obj
<<
/Annots [10 0 R 11 0 R 12 0 R 13 0 R 14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R
20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R
30 0 R 31 0 R]
/Contents 74 0 R
/CropBox [0 0 612 792]
/MediaBox [0 0 612 792]
/Parent 4 0 R
/Resources <<
/ColorSpace <<
/CS0 [/ICCBased 75 0 R]
>>
/ExtGState <<
/GS0 76 0 R
>>
/Font <<
/C0_0 77 0 R
/T1_0 78 0 R
/T1_1 79 0 R
/T1_2 80 0 R
/TT0 81 0 R
>>
/ProcSet [/PDF /Text /ImageC]
/XObject <<
/Im0 82 0 R
/Im1 83 0 R
/Im2 84 0 R
>>
>>
/Rotate 0
/Type /Page
>>
endobj
33 0 obj
<<
/Length 12
/BBox [0 0 175.08 20.88]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
34 0 obj
<<
/Differences [24 /breve /caron /circumflex /dotaccent /hungarumlaut /ogonek /ring /tilde 39
/quotesingle 96 /grave 128 /bullet /dagger /daggerdbl /ellipsis /emdash /endash
/florin /fraction /guilsinglleft /guilsinglright /minus /perthousand /quotedblbase /quotedblleft /quotedblright /quoteleft
/quoteright /quotesinglbase /trademark /fi /fl /Lslash /OE /Scaron /Ydieresis /Zcaron
/dotlessi /lslash /oe /scaron /zcaron 160 /Euro 164 /currency 166
/brokenbar 168 /dieresis /copyright /ordfeminine 172 /logicalnot /.notdef /registered /macron
/degree /plusminus /twosuperior /threesuperior /acute /mu 183 /periodcentered /cedilla /onesuperior
/ordmasculine 188 /onequarter /onehalf /threequarters 192 /Agrave /Aacute /Acircumflex /Atilde
/Adieresis /Aring /AE /Ccedilla /Egrave /Eacute /Ecircumflex /Edieresis /Igrave /Iacute
/Icircumflex /Idieresis /Eth /Ntilde /Ograve /Oacute /Ocircumflex /Otilde /Odieresis /multiply
/Oslash /Ugrave /Uacute /Ucircumflex /Udieresis /Yacute /Thorn /germandbls /agrave /aacute
/acircumflex /atilde /adieresis /aring /ae /ccedilla /egrave /eacute /ecircumflex /edieresis
/igrave /iacute /icircumflex /idieresis /eth /ntilde /ograve /oacute /ocircumflex /otilde
/odieresis /divide /oslash /ugrave /uacute /ucircumflex /udieresis /yacute /thorn /ydieresis]
/Type /Encoding
>>
endobj
35 0 obj
<<
/BaseFont /Helvetica
/Name /Helv
/Subtype /Type1
/Type /Font
>>
endobj
36 0 obj
<<
/Length 12
/BBox [0 0 167.64 20.88]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
37 0 obj
<<
/Length 12
/BBox [0 0 323.76 20.88]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
38 0 obj
<<
/Length 12
/BBox [0 0 95.64 21.12]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
39 0 obj
<<
/Length 12
/BBox [0 0 106.2 21.12]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
40 0 obj
<<
/Length 12
/BBox [0 0 123.96 21.12]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
41 0 obj
<<
/Length 12
/BBox [0 0 191.4 20.88]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
42 0 obj
<<
/Length 12
/BBox [0 0 177.6 21.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
43 0 obj
<<
/Length 12
/BBox [0 0 177.48 21.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
44 0 obj
<<
/Length 12
/BBox [0 0 177.48 21.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
45 0 obj
<<
/Length 12
/BBox [0 0 52.8 21.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
46 0 obj
<<
/Length 12
/BBox [0 0 52.68 21.24]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
47 0 obj
<<
/Length 12
/BBox [0 0 177.6 19.8]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
48 0 obj
<<
/Length 12
/BBox [0 0 223.32 25.8]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
49 0 obj
<<
/Length 12
/BBox [0 0 100.2 25.8]
/FormType 1
/Matrix [1 0 0 1 0 0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
/Tx BMC
EMC
endstream
endobj
50 0 obj
<<
/Length 56
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P0׳051S0ӳ072W(JJ23U a3)\ h
endstream
endobj
51 0 obj
<<
/Length 120
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
1~bJmֽM6hg#;E@0i1,cb-gOZWჁCo:لCv?>YGX@-֊'Be}Tq_ /c
endstream
endobj
52 0 obj
<<
/Length 50
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P0׳051S0ӳ072W(JJ23U a3)\ "
endstream
endobj
53 0 obj
<<
/Length 115
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̽
@~bJӬw{uFX4BicscbfZp{bĞxt;ng+F>fF
)PUmv!Ά+~ ',
endstream
endobj
54 0 obj
<<
/Length 56
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P0׳051S0ӳ072W(JJ23U a3)\ h
endstream
endobj
55 0 obj
<<
/Length 120
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
1~bJmֽM6hg#;E@0i1,cb-gOZWჁCo:لCv?>YGX@-֊'Be}Tq_ /c
endstream
endobj
56 0 obj
<<
/Length 50
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P0׳051S0ӳ072W(JJ23U a3)\ "
endstream
endobj
57 0 obj
<<
/Length 115
/BBox [0.0 0.0 7.85455 6.87271]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̽
@~bJӬw{uFX4BicscbfZp{bĞxt;ng+F>fF
)PUmv!Ά+~ ',
endstream
endobj
58 0 obj
<<
/Length 52
/BBox [0.0 0.0 7.52728 7.20001]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P03527RF
E\i\z
l7s !
endstream
endobj
59 0 obj
<<
/Length 115
/BBox [0.0 0.0 7.52728 7.20001]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H$̱
1~bJY7lu6`X')bTۘ@l*j7w=~,a-5X;Glxb
` 2
endstream
endobj
60 0 obj
<<
/Length 46
/BBox [0.0 0.0 7.52728 7.20001]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P03527RF
E\i\z
l7s u
endstream
endobj
61 0 obj
<<
/Length 112
/BBox [0.0 0.0 7.52728 7.20001]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H$̱
1~bJYlb-]#,v]w~l,bZ- }{պޱn
g*BM>c)}!
7 k!
endstream
endobj
62 0 obj
<<
/Length 56
/BBox [0.0 0.0 7.85455 6.87274]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P0׳051S0ӳ072W(JJ23U a3)\ h
endstream
endobj
63 0 obj
<<
/Length 120
/BBox [0.0 0.0 7.85455 6.87274]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
1~bJmֽM6hg#;E@0i1,cb-gOZWჁCo:لCv?>YGX@-֊'Be}Tq_ /c
endstream
endobj
64 0 obj
<<
/Length 50
/BBox [0.0 0.0 7.85455 6.87274]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P0׳051S0ӳ072W(JJ23U a3)\ "
endstream
endobj
65 0 obj
<<
/Length 115
/BBox [0.0 0.0 7.85455 6.87274]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̽
@~bJӬw{uFX4BicscbfZp{bĞxt;ng+F>fF
)PUmv!Ά+~ ',
endstream
endobj
66 0 obj
<<
/Length 52
/BBox [0.0 0.0 6.54547 6.54544]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P03515P&
E\i\z
l
2Ks fR
endstream
endobj
67 0 obj
<<
/Length 116
/BBox [0.0 0.0 6.54547 6.54544]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
@~bJmd )}P9H1RzNP*|?0B%_4>a4z_l.\7:sIT-4G||8+ %@R
endstream
endobj
68 0 obj
<<
/Length 46
/BBox [0.0 0.0 6.54547 6.54544]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P03515P&
E\i\z
l
2Ks
endstream
endobj
69 0 obj
<<
/Length 113
/BBox [0.0 0.0 6.54547 6.54544]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
@~bJӬq79[1]`, )`3qs/1~_ĹN?|TZe=q Ƙ9T9kn#Nf8Xx0 z
endstream
endobj
70 0 obj
<<
/Length 56
/BBox [0.0 0.0 8.18182 6.21817]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H23754VH2P0P30P0320R(JJ23U as)\ e
endstream
endobj
71 0 obj
<<
/Length 119
/BBox [0.0 0.0 8.18182 6.21817]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<ͱ
1~bJm&6hg#,vށ?
3Ij-sBb:b
#T~3Jx t^X#LrFUWdj=eɸc8# !I
endstream
endobj
72 0 obj
<<
/Length 50
/BBox [0.0 0.0 8.18182 6.21817]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/ProcSet [/PDF]
>>
/Subtype /Form
/Type /XObject
>>
stream
H2TH2P0P30P0320R(JJ23U as)\
endstream
endobj
73 0 obj
<<
/Length 116
/BBox [0.0 0.0 8.18182 6.21817]
/Filter /FlateDecode
/FormType 1
/Matrix [1.0 0.0 0.0 1.0 0.0 0.0]
/Resources <<
/Font <<
/ZaDb 9 0 R
>>
/ProcSet [/PDF /Text]
>>
/Subtype /Form
/Type /XObject
>>
stream
H<̱
@~bJm˭ٴ!vi XcS}ï袮Σd#d}R
e3%6
.jJm;*qˌg