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VERIFICATION
The undersigned hereby verifies that the statements of fact in the foregovng
document are true and correct to the best of my knowledge, information and belief. I
understand that any false statements therein are subject to the penalties contained in 18
Pa. C. S. § 4904, relating to unsworn falsification to authorities.
Dated: ~ - 2U ' 2U l U By: ~
Kristy Scott, Bus s Office Manager
Guardian Elder Care Community Services, LLC
d/b/a Forest Pazk Health Center
C7 0
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