I acknowledge that I am a resident of the state indicated above and the person making the request noted. I acknowledge that I am making this request in good faith on behalf of myself

I CERTIFY AND DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF MY RESIDENT STATE INDICATED ABOVE AND THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT AND THAT I AM THE CONSUMER WHOSE PERSONAL INFORMATION IS THE SUBJECT OF THE REQUEST.