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. , <br /> � � <br /> Legal Status (check one) : <br /> Individual <br /> �( Government entit <br /> Y <br /> Owner of sole ro rietorshi <br /> p p p Nonresident alien individual <br /> Partnership Estate or legal trust <br /> Tax-exempt hospital or Foreign corporatic� <br /> extended care facility partnership estat'� or trust <br /> Corporation providing or Other - not-for-profit <br /> billing medical and/or organization: <br /> health care services <br /> Corporation NOT providing or Other: <br /> billing medical and/or <br /> health care services <br /> The Grantee acknowledges that the individual signing below is authorized <br /> to execute this Agreement and that such signature constitutes the <br /> acceptance of this Agreement . <br /> GR�INTEE: <br /> City of Decatu catur Police Department <br /> B . --- - --- — - - !_�Ot� /� �-1 <br /> (Sign Print or Type <br /> ATTES � �`�u� <br /> STATE OF LLINOIS DEPART ENT OF OMMERCE AND CONII�IUNITY AFFAIRS <br /> BY: �i�--.(��,o g ia - Z-� <br /> Pam McDonough, Directo �(/� Date <br /> Grantee Address : <br /> Please indicate any changes below <br /> � <br /> for Decatur Police De artment <br /> P <br /> One Gary K. Anderson Plaza <br /> Decatur, IL 62523-1005 <br /> Chief Exec : Terry Howley <br /> Phone : (217) 424 - 2741 <br /> The following is designated as administrator for the Grantee: <br /> Chief Exec : <br /> Phone: <br /> 11/09/2000 10 :34 :22 - 2 - I <br />