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20-3271556 <br />(IRS Identification No.) <br />(Address to which all correspondence and notifications <br />are to be sent — if different fro legal address) <br />L4 <br />(S'gnature) <br />Owner <br />(Title) <br />(651) 287-5390 <br />(Telephone Number) <br />List of References <br />1. Ms. Jackie Klein (651) 366-3637 MN/DOT <br />2. Mr. Mark Davis (612) 341-3242 Davis Real Estate <br />3, Mr. Mark Larson (320) 864-6500 City of Glencoe <br />Page 2 of 2 <br />