%PDF-1.3
%âãÏÓ
1 0 obj
<<
/Producer (OmniForm Converter for PDF)
/Creator (OmniForm Premium)
>>
endobj
4 0 obj
[ /PDF /Text ] 
endobj
6 0 obj
<< /Length 7 0 R >>
stream
BT
/F0 12 Tf
0 g 241.526 764.362 Td 99 Tz (University Of Missouri) Tj
/F0 18 Tf
-76.198 -16.696 Td 100 Tz (Employee Separation Check List) Tj
/F1 10 Tf
-110.367 -17.43 Td 97 Tz (Columbia) Tj
180 0 Td 92 Tz (Rolla) Tj
64.8 0 Td 91 Tz (St. Louis) Tj
-162.003 0 Td 90 Tz (Kansas City) Tj
244.803 0 Td 99 Tz ( Hospitals and Clinics) Tj
144 0 Td 93 Tz (UM System) Tj
/F1 7 Tf
-503.314 -16.143 Td 106 Tz (TO: Name) Tj
210.96 -0.24 Td 96 Tz (EMPLID) Tj
101.52 -0.238 Td 99 Tz (Department) Tj
ET
.75 w
0 G
2 J
230.4 667.312 363.6 27.119 re
S
BT
23.729 686.974 Td 94 Tz (FROM:) Tj
/F1 10 Tf
238.799 -11.049 Td 91 Tz (Separation) Tj
86.64 -0.479 Td (Transfer) Tj
52.319 -0.72 Td 89 Tz (Effective Date) Tj
-375.12 -26.88 Td 99 Tz (This is to confirm your last working date with this department will be) Tj
482.193 -0.794 Td 97 Tz (Please call my) Tj
-482.434 -12.166 Td 99 Tz (office to set a time to complete the necessary checkout procedures. Please bring with you the following University property) Tj
-0.479 -11.999 Td (which our records indicate has been issued to you.) Tj
/F0 10 Tf
129.6 -16.56 Td 96 Tz (DATE) Tj
-58.56 -9.122 Td 94 Tz (Issued) Tj
102.002 0 Td 98 Tz (Returned) Tj
/F1 10 Tf
92.639 -16.798 Td 97 Tz (Uni-Card - Airfare \(#) Tj
0 -18.482 Td (Uni-Card - Purchasing \(#) Tj
-0.24 -19.44 Td 99 Tz (Corporate Travel Card) Tj
0 -18.72 Td 98 Tz (University Club Card) Tj
0 -18.238 Td 96 Tz (Keys, Card Keys \(Office, Building, Other\)) Tj
-0.238 -18.479 Td 99 Tz (Parking Permit) Tj
-0.482 -18.479 Td 98 Tz (Tools/Equipment) Tj
0.482 -18.723 Td 97 Tz (Uniforms) Tj
0 -18.72 Td 95 Tz (University I. D. Card) Tj
0 -18.24 Td 98 Tz (Division/Department I.D. Badge) Tj
-0.72 -18.479 Td 95 Tz (Telephone Calling Card) Tj
0.479 -18.96 Td 98 Tz (Other) Tj
-264.01 -21.489 Td 99 Tz (The following check list is to assist the person conducting the check out.) Tj
52.92 -15 Td 101 Tz /F0 10 Tf (Authorization and Other Exit Items) Tj
/F1 10 Tf
211.09 -17.748 Td 99 Tz (Any Outstanding Fine/Fees to be Paid) Tj
0.96 -17.28 Td (Bi-Weekly Time Sheet Signed/Submitted) Tj
-0.24 -19.44 Td (Monthly Absence Summary Completed) Tj
0 -18.482 Td 95 Tz (PAF \(transfer/termination\) Processed \(include leave accrual info\)) Tj
-0.479 -18 Td (Computer Account\(s\) Deleted) Tj
0.238 -18.479 Td 99 Tz (Security System Access Deleted) Tj
-0.72 -18 Td (Voice Mail Access and Message Changed) Tj
0.24 -18.479 Td 100 Tz (WATS Access Number Deleted) Tj
0.72 -18.482 Td (University and/or Div./Dept. I. D. Cards Destroyed) Tj
-0.24 -18.24 Td 98 Tz (Division/Department I.D. Badge) Tj
-0.238 -18.24 Td 96 Tz (Clean Out Lockers, Desk, etc.) Tj
0 -18.24 Td 98 Tz (Other) Tj
ET
2 J
18.689 80.75 206.16 26.88 re
S
2 J
224.847 80.75 76.32 26.88 re
S
2 J
301.167 80.75 217.199 26.88 re
S
2 J
518.369 80.75 75.631 26.88 re
S
BT
/F1 7 Tf
305.249 100.894 Td (Supervisor's Signature) Tj
-76.082 -0.479 Td 95 Tz (Date) Tj
293.28 0 Td 94 Tz (Date) Tj
-499.68 -0.24 Td 97 Tz (Employee Signature at Hire) Tj
ET
2 J
18.689 53.631 206.16 27.119 re
S
2 J
224.847 53.631 76.32 27.119 re
S
2 J
301.167 53.631 217.199 27.119 re
S
2 J
518.369 53.631 75.631 27.119 re
S
BT
522.207 73.774 Td 94 Tz (Date) Tj
-293.278 -0.24 Td 95 Tz (Date) Tj
-206.402 -0.482 Td 98 Tz (Employee Signature at Exit) Tj
/F1 10 Tf
-1.199 -31.207 Td 100 Tz (This form should be completed for all ) Tj
/F0 10 Tf (transferring ) Tj
/F1 10 Tf (or ) Tj
/F0 10 Tf (separating) Tj
/F1 10 Tf ( employees. ) Tj
/F0 10 Tf (The completed checklist should be returned) Tj
0.24 -10.8 Td (to the Human Resources department along with the transfer/terminating PAF.) Tj
/F1 7 Tf
0.992 -11.718 Td 115 Tz (UM 27 \(MAY 07\) 5/7/07) Tj
/F1 10 Tf
478.837 627.554 Td 100 Tz (.) Tj
28 -65.531 Td (\)) Tj
19.500 -20.001 Td (\)) Tj
/F1 7 Tf
-243.649 -487.460 Td 98 Tz (Supervisor's Signature) Tj
ET
2 J
35.073 729.133 14.4 11.76 re
S
2 J
213.871 729.136 14.159 11.999 re
S
2 J
359.552 729.615 14.159 11.999 re
S
2 J
506.673 729.615 13.92 11.999 re
S
2 J
19.647 694.429 210.753 26.88 re
S
2 J
230.4 694.429 101.248 26.88 re
S
2 J
331.648 694.429 262.352 26.88 re
S
2 J
19.647 667.312 210.753 27.119 re
S
2 J
240.928 673.31 14.4 11.999 re
S
2 J
327.569 672.352 15.12 13.439 re
S
2 J
573.089 673.31 m
462.688 673.31 l
S
2 J
500.610 645.95 m
327.569 645.95 l
S
2 J
262.8 302.990 m
64.8 302.990 l
S
2 J
262.8 284.752 m
64.8 284.752 l
S
2 J
151.44 578.699 m
68.4 578.699 l
S
2 J
262.8 227.849 m
64.8 227.849 l
S
2 J
262.8 173.407 m
64.8 173.407 l
S
2 J
262.8 155.259 m
64.8 155.259 l
S
2 J
278.192 729.374 14.159 11.999 re
S
2 J
118.111 729.374 14.159 11.999 re
S
2 J
255.84 578.699 m
172.8 578.699 l
S
2 J
151.44 560.551 m
68.4 560.551 l
S
2 J
255.84 560.551 m
172.8 560.551 l
S
2 J
151.44 542.404 m
68.4 542.404 l
S
2 J
255.84 542.404 m
172.8 542.404 l
S
2 J
151.44 521.232 m
68.4 521.232 l
S
2 J
255.84 521.232 m
172.8 521.232 l
S
2 J
151.44 503.084 m
68.4 503.084 l
S
2 J
255.84 503.084 m
172.8 503.084 l
S
2 J
151.44 484.937 m
68.4 484.937 l
S
2 J
255.84 484.937 m
172.8 484.937 l
S
2 J
151.44 466.790 m
68.4 466.790 l
S
2 J
255.84 466.790 m
172.8 466.790 l
S
2 J
151.44 448.642 m
68.4 448.642 l
S
2 J
255.84 448.642 m
172.8 448.642 l
S
2 J
151.44 430.495 m
68.4 430.495 l
S
2 J
255.84 430.495 m
172.8 430.495 l
S
2 J
151.44 412.347 m
68.4 412.347 l
S
2 J
255.84 412.347 m
172.8 412.347 l
S
2 J
151.44 394.2 m
68.4 394.2 l
S
2 J
255.84 394.2 m
172.8 394.2 l
S
2 J
151.44 373.028 m
68.4 373.028 l
S
2 J
255.84 373.028 m
172.8 373.028 l
S
2 J
262.8 318.586 m
64.8 318.586 l
S
2 J
262.8 267.168 m
64.8 267.168 l
S
2 J
262.8 247.521 m
64.8 247.521 l
S
2 J
262.8 209.701 m
64.8 209.701 l
S
2 J
262.8 191.554 m
64.8 191.554 l
S
2 J
259.951 137.112 m
64.8 137.112 l
S
2 J
259.951 118.964 m
64.8 118.964 l
S
endstream
endobj
7 0 obj
5705 
endobj
5 0 obj
<<
/Type /Page
/Parent 3 0 R
/Resources << /ProcSet [ /PDF /Text ] /Font << /F0 8 0 R /F1 11 0 R >> >>
/MediaBox [ 0 0 612 792 ]
/Contents 6 0 R
/Annots 67 0 R
>>
endobj
14 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 35 729 49 743 ]
/T (FillText2)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
18 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 214 729 228 743 ]
/T (FillText3)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
19 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 360 730 374 743 ]
/T (FillText4)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
20 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 507 730 521 743 ]
/T (FillText5)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
21 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 20 694 230 721 ]
/T (TO_Name)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Ff 4096
>>
endobj
22 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 230 694 332 721 ]
/T (EMPLID)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Ff 4096
/Q 1
>>
endobj
23 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 332 694 594 721 ]
/T (Department)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Ff 4096
>>
endobj
24 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 20 667 230 694 ]
/T (FROM)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Ff 4096
>>
endobj
25 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 241 673 255 687 ]
/T (FillText6)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
26 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 328 672 343 686 ]
/FT /Btn
/H /T
/T (Transfer)
/F 4
/AS /Off
/DA (0 g /ZaDb 17 Tf)
/AP
<<
/N << /1 70 0 R /Off 71 0 R >>
/D << /1 70 0 R /Off 71 0 R >>
>>
>>
endobj
70 0 obj
<< 
/Resources << /ProcSet [/PDF /Text] /Font << /ZaDb 69 0 R >> >>
/BBox [ 0 0 15 13 ]
/MK << /CA (8) >>
/Length 52
>>
stream
BT 0 g /ZaDb 17 Tf 1 0 0 1 1.8  0.839  Tm (8) Tj
ET
endstream
endobj
71 0 obj
<< 
/Resources << /ProcSet [/PDF] >>
/BBox [ 0 0 15 13 ]
/Length 3
>>
stream
0 G
endstream
endobj
27 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 463 673 573 687 ]
/T (Effective_Date)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/AA << /F 72 0 R >>
>>
endobj
72 0 obj
<< 
/S /JavaScript 
/JS (AFDate_FormatEx\("m/d/yy"\);)
>> 
endobj
28 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 328 646 501 659 ]
/T (This_is_to_confirm_your_last_working_date_with_thi)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/AA << /F 73 0 R >>
>>
endobj
73 0 obj
<< 
/S /JavaScript 
/JS (AFDate_FormatEx\("m/d/yy"\);)
>> 
endobj
29 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 303 263 316 ]
/T (FillText7)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
30 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 285 263 298 ]
/T (FillText8)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
31 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 579 151 592 ]
/T (FillText11)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
32 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 228 263 241 ]
/T (FillText13)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
33 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 173 263 187 ]
/T (FillText14)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
34 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 155 263 169 ]
/T (FillText15)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
35 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 278 729 292 743 ]
/T (FillText18)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
36 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 118 729 132 743 ]
/T (FillText19)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
37 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 579 256 592 ]
/T (FillText20)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
38 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 561 151 574 ]
/T (FillText21)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
39 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 561 256 574 ]
/T (FillText22)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
40 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 542 151 556 ]
/T (FillText23)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
41 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 542 256 556 ]
/T (FillText24)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
42 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 521 151 535 ]
/T (FillText25)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
43 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 521 256 535 ]
/T (FillText26)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
44 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 503 151 516 ]
/T (FillText27)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
45 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 503 256 516 ]
/T (FillText28)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
46 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 485 151 498 ]
/T (FillText29)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
47 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 485 256 498 ]
/T (FillText30)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
48 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 467 151 480 ]
/T (FillText31)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
49 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 467 256 480 ]
/T (FillText32)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
50 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 449 151 462 ]
/T (FillText33)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
51 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 449 256 462 ]
/T (FillText34)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
52 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 430 151 444 ]
/T (FillText35)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
53 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 430 256 444 ]
/T (FillText36)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
54 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 412 151 426 ]
/T (FillText37)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
55 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 412 256 426 ]
/T (FillText38)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
56 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 394 151 408 ]
/T (FillText39)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
57 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 394 256 408 ]
/T (FillText40)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
58 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 68 373 151 386 ]
/T (FillText41)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
59 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 173 373 256 386 ]
/T (FillText42)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
/Q 1
>>
endobj
60 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 319 263 332 ]
/T (FillText43)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
61 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 267 263 281 ]
/T (FillText44)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
62 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 248 263 261 ]
/T (FillText45)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
63 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 210 263 223 ]
/T (FillText46)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
64 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 192 263 205 ]
/T (FillText47)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
65 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 137 260 151 ]
/T (FillText48)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
66 0 obj
<< 
/Type /Annot
/Subtype /Widget
/Rect [ 65 119 260 132 ]
/T (FillText49)
/FT /Tx
/DA (/TiRo 10 Tf 0 g)
/Maxlen 16000
/F 4
>>
endobj
67 0 obj
[
14 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 32 0 R 
33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 
41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 
49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 
57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 
65 0 R 66 0 R 
]
endobj
74 0 obj
<<
/AcroForm 0.8
/DR 75 0 R
/DA (/TiRo 10 Tf 0 g)
/Fields
[
14 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 32 0 R 
33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 
41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 
49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 
57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 
65 0 R 66 0 R 
]
>>
endobj
75 0 obj
<< 
/Font << /TiRo 68 0 R /ZaDb 69 0 R >>
>>
endobj
68 0 obj
<< 
/Type /Font
/Subtype /Type1
/Name /TiRo
/BaseFont /Times-Roman
/FirstChar 32
/LastChar 255
/Encoding 76 0 R
>>
endobj
69 0 obj
<< 
/Type /Font
/Subtype /Type1
/Name /ZaDb
/BaseFont /ZapfDingbats
/FirstChar 32
/LastChar 255
>>
endobj
76 0 obj
<< 
/Type /Encoding
/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
]
>>
endobj
8 0 obj
<< 
/Type /Font
/Subtype /TrueType
/Name /F0
/BaseFont /Arial,Bold
/FirstChar 30
/LastChar 255
/Encoding /WinAnsiEncoding
/FontDescriptor 9 0 R
/Widths 10 0 R
>>
endobj
9 0 obj
<< 
/Type /FontDescriptor
/Flags 32
/FontName /Arial,Bold
/FontBBox [ -628 -376 2000 1010 ]
/MissingWidth 750
/StemV 85
/StemH 85
/ItalicAngle 0
/CapHeight 905
/XHeight 633
/Ascent 905
/Descent -212
/Leading 150
/MaxWidth 2628
/AvgWidth 479
>>
endobj
10 0 obj
[
750 750 278 333 474 556 556 889 722 238 333 333 389 584 278 333 
278 278 556 556 556 556 556 556 556 556 556 556 333 333 584 584 
584 611 975 722 722 722 722 667 611 778 722 278 556 722 611 833 
722 778 667 778 722 667 611 722 667 944 667 667 611 333 278 333 
584 556 333 556 611 556 611 556 333 611 611 278 278 556 278 889 
611 611 611 611 389 556 333 611 556 778 556 556 500 389 280 389 
584 750 556 750 278 556 500 1000 556 556 333 1000 667 333 1000 750 
611 750 750 278 278 500 500 350 556 1000 333 1000 556 333 944 750 
500 667 278 333 556 556 556 556 280 556 333 737 370 556 584 333 
737 552 400 549 333 333 333 576 556 278 333 333 365 556 834 834 
834 611 722 722 722 722 722 722 1000 722 667 667 667 667 278 278 
278 278 722 722 778 778 778 778 778 584 778 722 722 722 722 667 
667 611 556 556 556 556 556 556 889 556 556 556 556 556 278 278 
278 278 611 611 611 611 611 611 611 549 611 611 611 611 611 556 
611 556 
]
endobj
11 0 obj
<< 
/Type /Font
/Subtype /TrueType
/Name /F1
/BaseFont /Arial
/FirstChar 30
/LastChar 255
/Encoding /WinAnsiEncoding
/FontDescriptor 12 0 R
/Widths 13 0 R
>>
endobj
12 0 obj
<< 
/Type /FontDescriptor
/Flags 32
/FontName /Arial
/FontBBox [ -665 -325 2000 1006 ]
/MissingWidth 750
/StemV 85
/StemH 85
/ItalicAngle 0
/CapHeight 905
/XHeight 633
/Ascent 905
/Descent -212
/Leading 150
/MaxWidth 2665
/AvgWidth 441
>>
endobj
13 0 obj
[
750 750 278 278 355 556 556 889 667 191 333 333 389 584 278 333 
278 278 556 556 556 556 556 556 556 556 556 556 278 278 584 584 
584 556 1015 667 667 722 722 667 611 778 722 278 500 667 556 833 
722 778 667 778 722 667 611 722 667 944 667 667 611 278 278 278 
469 556 333 556 556 500 556 556 278 556 556 222 222 500 222 833 
556 556 556 556 333 500 278 556 500 722 500 500 500 334 260 334 
584 750 556 750 222 556 333 1000 556 556 333 1000 667 333 1000 750 
611 750 750 222 222 333 333 350 556 1000 333 1000 500 333 944 750 
500 667 278 333 556 556 556 556 260 556 333 737 370 556 584 333 
737 552 400 549 333 333 333 576 537 278 333 333 365 556 834 834 
834 611 667 667 667 667 667 667 1000 722 667 667 667 667 278 278 
278 278 722 722 778 778 778 778 778 584 778 722 722 722 722 667 
667 611 556 556 556 556 556 556 889 500 556 556 556 556 278 278 
278 278 556 556 556 556 556 556 556 549 611 556 556 556 556 500 
556 500 
]
endobj
15 0 obj
<< 
/Type /Font
/Subtype /TrueType
/Name /F2
/BaseFont /TimesNewRoman
/FirstChar 30
/LastChar 255
/Encoding /WinAnsiEncoding
/FontDescriptor 16 0 R
/Widths 17 0 R
>>
endobj
16 0 obj
<< 
/Type /FontDescriptor
/Flags 34
/FontName /TimesNewRoman
/FontBBox [ -568 -307 2000 1007 ]
/MissingWidth 778
/StemV 85
/StemH 85
/ItalicAngle 0
/CapHeight 891
/XHeight 623
/Ascent 891
/Descent -216
/Leading 149
/MaxWidth 2568
/AvgWidth 401
>>
endobj
17 0 obj
[
778 778 250 333 408 500 500 833 778 180 333 333 500 564 250 333 
250 278 500 500 500 500 500 500 500 500 500 500 278 278 564 564 
564 444 921 722 667 667 722 611 556 722 722 333 389 722 611 889 
722 722 556 722 667 556 611 722 722 944 722 722 611 333 278 333 
469 500 333 444 500 444 500 444 333 500 500 278 278 500 278 778 
500 500 500 500 333 389 278 500 500 722 500 500 444 480 200 480 
541 778 500 778 333 500 444 1000 500 500 333 1000 556 333 889 778 
611 778 778 333 333 444 444 350 500 1000 333 980 389 333 722 778 
444 722 250 333 500 500 500 500 200 500 333 760 276 500 564 333 
760 500 400 549 300 300 333 576 453 250 333 300 310 500 750 750 
750 444 722 722 722 722 722 722 889 667 611 611 611 611 333 333 
333 333 722 722 722 722 722 722 722 564 722 722 722 722 722 722 
556 500 444 444 444 444 444 444 667 444 444 444 444 444 278 278 
278 278 500 500 500 500 500 500 500 549 500 500 500 500 500 500 
500 500 
]
endobj
3 0 obj
<< 
/Type /Pages 
/Count 1 
/Kids [ 5 0 R ]
/MediaBox [ 0 0 612 792 ]
>>
endobj
2 0 obj
<< 
/Type /Catalog 
/Pages 3 0 R 
/AcroForm 74 0 R
>> 
endobj
xref
0 77
0000000000 65535 f
0000000015 00000 n
0000020705 00000 n
0000020617 00000 n
0000000103 00000 n
0000005913 00000 n
0000000134 00000 n
0000005892 00000 n
0000016474 00000 n
0000016651 00000 n
0000016910 00000 n
0000017855 00000 n
0000018029 00000 n
0000018284 00000 n
0000006091 00000 n
0000019230 00000 n
0000019412 00000 n
0000019675 00000 n
0000006232 00000 n
0000006375 00000 n
0000006518 00000 n
0000006661 00000 n
0000006810 00000 n
0000006964 00000 n
0000007117 00000 n
0000007263 00000 n
0000007406 00000 n
0000007936 00000 n
0000008179 00000 n
0000008458 00000 n
0000008600 00000 n
0000008742 00000 n
0000008890 00000 n
0000009033 00000 n
0000009176 00000 n
0000009319 00000 n
0000009463 00000 n
0000009607 00000 n
0000009756 00000 n
0000009904 00000 n
0000010053 00000 n
0000010201 00000 n
0000010350 00000 n
0000010498 00000 n
0000010647 00000 n
0000010795 00000 n
0000010944 00000 n
0000011092 00000 n
0000011241 00000 n
0000011389 00000 n
0000011538 00000 n
0000011686 00000 n
0000011835 00000 n
0000011983 00000 n
0000012132 00000 n
0000012280 00000 n
0000012429 00000 n
0000012577 00000 n
0000012726 00000 n
0000012874 00000 n
0000013023 00000 n
0000013166 00000 n
0000013309 00000 n
0000013452 00000 n
0000013595 00000 n
0000013738 00000 n
0000013881 00000 n
0000014024 00000 n
0000014900 00000 n
0000015031 00000 n
0000007622 00000 n
0000007828 00000 n
0000008104 00000 n
0000008383 00000 n
0000014401 00000 n
0000014839 00000 n
0000015146 00000 n
trailer
<<
/Size 77 
/Root 2 0 R
/Info 1 0 R
>>
startxref
20776
%%EOF