E05 PM PAGE rs gegegg flgeegg 3 tab 88 Sign 2 ??taEm9?3 get at $'r'3W UIIUV "Raga an "him 3 antic) as 3' meg it tatea gfi Aflgavrr on (3-3 I, the effient named below. after being swo state _under oath that on or about (date 0 incidentCUUHW. T'gnng35??_ II I I .con1n1itted the oH"ense(s) ef of TCA at:t:tit:tn(s) 3 I further state under oath that the essential facts constituting the effense(s). the sources of my and the reasons why this infennation is believable and table are as follows: 7"4fl<