Free Additional Attachments to Main Document - District Court of Arizona - Arizona


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EXHIBIT 64
Case 2:OO—cv—O1118—NVW Document 114-6 Filed O3/28/2007 Page1 of 2

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Case 2:00-cv-01118-NVW

Document 114-6

Filed 03/28/2007

Page 1 of 2

Case 2:00-cv-01118-NVW

Document 114-6

Filed 03/28/2007

Page 2 of 2