HomeMy WebLinkAbout0132 SCUDDER BAY CIRCLE '� � r � � '� s YEN �'
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Tow_ n of Barnstable Building
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s Post This Card'So That it is Visible From the Street-Approved'Plans Must be Retained on Job and this Card Must'be Kept
HAMSTA
163
`�P Posted Until Final Inspection Has Been Made.. �,y.ml�
Where a Certificate:of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made . . Permit
Permit NO. B-19-656 Applicant Name: Dzmitry Labkovich Approvals
Date Issued: 03/01/2019 Current Use: I Structure
Permit Type: Building-Addition/Alteration- Residential Expiration Date: 09/01/2019 Foundation:
Location: 132 SCUDDER BAY CIRCLE,CENTERVILLE Map/Lot 187-020 Zoning District: RD-1 Sheathing:
Owner on Record: SWARTZ,JEFFREY C Contractor Name:',,ROOFING AND SIDING OF CAPE Framing: 1
'COD LLC.
Address: 132 SCUDDER BAY CIRCLE 2
.Contractor License: 170787
CENTERVILLE, MA 02632 Chimney:
u
Est..Pro'ect Cost: 9 315.00
New roof i '� J $ ,
Descri lion: a o0
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i
Insulation:
Permit Fee:
97.51
Project Review Re :
�
Fee Paid: $97.51 Final.
0
Date:` 3/1/2019
Plumbing/Gas
. Rough Plumbing:
Final Plumbing:
I
Building Official
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This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved application and the approved construction_documents for which this permit has been granted.
i ' 3 .Final Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This.permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. ' Electrical
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nc will not be issued until all applicable signatures b the Building and Fire Officials are,provided on this permit.
Service:
The Certificate of Occupancy P
P Y PP g Y g
Minimum of Five Call Inspections Required for All Construction Work: Rough:
1.Foundation or Footing
2.Sheathing Inspection
Final:
s
3.
All FireplacesP
must be inspected at the throat level before fir e t flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �N` E
Town of Barnstable _
. . . _ _ ._ _ ]Building
; Post This Card So Tlat it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept ,
MASS. ��$ Posted Until Final Inspection Has Been Made.2619.
,, ��� ��
°rfo Ma+° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied"until a.Final Inspection has been made. � I
Permit NO. B-19-491 Applicant Name: Lloyd R Smith Vivint Solar LLC Approvals
Date Issued: 03/04/2019 Current Use: Structure
Permit Type: Building-Solar Panel-Residential Expiration Date: 09/04/2019 foundation:
Location: 132 SCUDDER BAY CIRCLE,CENTERVILLE Map/Lot: 187-020 Zoning District: RD-1 Sheathing:
Owner on Record: SWARTZ,JEFFREY C ; - Contractor Name: ..BRIEN LANGILL Framing: 1
Address: 132SCUDDER BAY CIRCLE Contractor License:' CS-106675 2
CENTERVILLE, MA 02632 Est. Project Cost: $32,054.00 Chimney:
Description: Installation of roof mounted photovoltaic solar systems 14:57 kw 47 Permit Fee:. $213.48
Panels Insulation:
_ Fee Paid: $213.48
Project Review Req: ' Date:. 3/4/2019
Final: G
Plumbing/Gas
Rough Plumbing:
tt
This permit shall be deemed abandoned and invalid unless the work authorized.by this permit is commenced withinaix months after issuan icial Final Plumbing:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas:
This permit shall be displayed in a location clearly visible from access streetor road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. a Final Gas-
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work:i
1.Foundation or Footing Service:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed reµ ,�_ - Rough: .
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Final:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Rough:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final:
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Final:
ONE-riE
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SolarCity
June 21, 20.16
Town of Barnstable
ATTENTION., BUILDING DEPARTMENT
200 Main Street
Hyannis, MA 02601
RE: 132 Scudder Bay Circle, Centerville,
Permit No.: B-2016-0256
Our Job No.: JB-0262449
NOTICE OF CANCELLATION
This letter is to certify our proposal to install Solar(PV) at the above
referenced property has been moved into a cancellation status.
SolarCity Corporation and Jeffrey Swartz will not be moving forward with
the proposed installation at this time. We would greatly appreciate
reimbursement for the permitting fees paid, but understand that the town
will not refund any fees.
If you have any questions or concerns, please don't hesitate to contact me.
Thank you for your attention to this matter.
0
Sincerely,
CheryCGruenstern
ILA
Cheryl Gruenstern cm
Permit Coordinator
Direct Line: (508) 640-5397
cgruenstern@so larcity.com
. a
112 Great Western Road,South Dennis,MA 02660 T (888)SOL-CITY solarcity.com
AL 05500.AR M-8937.AZ ROC 243771/ROC 245450.CA CSLB 888104.CO EC8041.CT HIC 0632778/ELC 0125305.DC 410514000080/ECC902585.DE 2 01112 0 3 8 6/T1-6032.FL ECIS006226.HI CT-29770.IL 15-0052.MA HIC 168572/
EL-1136MR.MD HIC 12 8 94 8/11B 05.NC 308014J.NH 0347C/12523M.NJ NJHICN13VH06160600/34EB01732700.NM EE98-379590.NV NV20121135172/C2-0078648/82-0079719.OH EL.47707.OR CBIB0498/C562.PA HICAA077343.RI
AC004714/Reg 38313.TX TECL27006.LIT.8726950-5501.VA ELE2705153278.Vr EM-05B29.WA SOLARC'91901/SOLARC'905P7.Albany 439.Greene A-486.Nassau H240971000Q Putnam PC6041.Rockland H-11664-40-00-00.Suffolk
52057-H.Westchester WC-26088-1-173.N.Y.0#2001384-0CA SCENYC:N.Y.C.Licensed Bectrician.#12610.#004485.155 Water St 6th Fl..Unit 10.Brooklyn.NY 11201#2013966-0CA All loans provided by SolarCity Finance Company.LLC..
CA Finance Lenders License.6054796.SolarCity Finance Company.LLC is licensed b7 the Delaware State Bank Commissioner to engage in business in Delaware under license number 019422,MD Consumer Loan License 2241.NV
Installment Loan License IL11023/1L11024..III Licensed Lender#20153103LL.TX Registered Creditor 1400050963-202404.VT Lender License#6766 -
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' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application # ��l d a�
Health Division Date Issued ��/4jvz
Conservation Division Application Fee
Planning Dept. Permit Fee �3q• v
Date Definitive Plan Approved by Planning Board (,
Historic - OKH -do _ Preservation/ Hyannis
Project Street Address � �-��
Village
Owner �� ��I C (. �'r Z- Address ccteA )04A�f e
Telephone 6 ls- V M 0— M":�
Permit Request -�-�15 -�� sou_,, ��S 1�0 I't is c �`sou_,,
��c� acS e 5� Icy164 new W1W CT, V&�e_(55 v� . 3.la K�
Square feet: 1 st floor: existing — proposed 2nd floor: e ' ' proposed Total new
Zoning District Flood Plain Groundwater Overlay
� �
Project Valuations utwb Constru Type
Lot Size Gra fat ere : ❑Yes �-No If yes, attach supporting documentation.
Dwelling Type: Single amity Tw Family ❑ Multi-Family(# units)
Age of Existing Struct re \ Historic House: ❑Yes U No On Old King's Highway: ❑Yes �o
Basement Type: ❑ II ❑ Crawl Walkout ❑ Other
Basement Finished Ar (sq.ft.) _ Basement Unfinished Area (sq.ft)
Number of Baths: Full: exi new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
.Meat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other N/
Central Air: ❑Yes ❑ No Fireplaces: Existino�LNew Existing wood/coal stoye: LWes 0 No
Detached garage: ❑ existing ❑ new si Pool: ❑ existing ❑ new size Barn existing-❑ nsW size_
Attached garage: ❑existing ❑ new siz4j hed: ❑ existing ❑ new size�Othe `-
-g -
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes to If yes, site plan review#
rn
Current Proposed Use VIC h
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) -
Name �t Telephone Number
Address a �' VL o- License # �S (ba A (_
l 5 C) & 6 Home Improvement Contractor#
Email oi-, Worker's Compensation # Lnjo 12c)6 /,
ALL COU RUCTION DEBRIS RESULTING ROM THIS PROJECT WILL BETAKEN TO a d,&kkh PnY,!�4_
'-� 4-C t,// r11- KK ,
SIGNATURE - DATE
t
FOR OFFICIAL USE ONLY F
APPLICATION #
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNERNlI }'
T
DATE OF INSPECTION: r
FOUNDATION
FRAME
INSULATION '
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH F AL-1
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
• t
DocuSign Envelope ID.49606895-1 C47-45D4-B691-0200D44498D2
SolarCitIPPA 91-
Y AMENDMENT
Customer Name and Address Installation Location Date
Jeffrey C Swartz 132 Scudder Bay Cir 1/7/2016
Barnstable,MA 02632
132 Scudder Bay Cir
Centerville,MA 02632
p Congratulations!
Your system design is complete and you are on your way to clean,more affordable energy. Based on the information in your System
design,there are some amendments we need to make to your Power Purchase Agreement(the"PPA").The amendments are as
follows: i
• We estimate that your System's first year annual production will be 2,593 kWh and we estimate that your average first year
monthly payments will be$27.01.Over the next 20 years we estimate that your System will produce 49,474 kWh.We also
confirm that your electricity rate will be$0.1250 per kWh,(i.e.electricity rate$0.1250 and tax rate$0.0000). Your electricity
rate,exclusive of taxes,will never increase more than 2.90%per year.
By signing below,you are agreeing to amend your PPA and you are agreeing to all of the new terms above. If you have any
questions or concerns please contact your Sales Representative.
Customer's Name:Jeffrey C Swartz Power Purchase Agreement Amendment
DocuSignedrby: - -
Signature:
oCEo A,AB4V6... SolarCity
Date: 1/7/?n1 F
approved
Customer's Name:
y Signature:
Signature: Lyhdon Rive, CEO
Date: Date: 12/29/2015
f
3055 Clearview Way,San,Mateo,CA 94402. 1 888.765.2489 1.solarcity.com
Power Purchase Agreement Amendment,version 2.0.1,June 25,2015
Contractor License MA HIC 168572/EL-1136MR
Document generated on 12/29/2015
1441723
~w�,,,SolarCit ,
OWNER AUTHORIZATION
Job#: OZ-U AL4S-cam
Property Address: j . Z Sc vkc9Jc.,' Lt r MA v2(a3 Z_
I as Owner of the subject
property hereby authorize SOLARCITY CORPORATION to act on my behalf,
in all matters relative to work authorized by this building permit application.
Signature of Owner: Date:
SOLARCITY:COM
R.:. •ys..w ,,./-'a3. r,'^A COC—A' r s.Ct: l r S�e�+lw -
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Town of Barnstable *Permit# J5 - -A-,
0 Expires 6 months from issue date
Regulatory Services Fee
� s
+ BAMSrABM
9 'ASS, Richard V.Scat,Director
�'ED6MA'� �
Building Divisidi6 "
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601 SEE 14 2016
www.town.bamstable.ma.us JCf U
Office: 508-862-4038 TOWN U BARNS] :F08-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number LU 02-0
Property Address /52— 5_rg ddfj y (1,-e.le_ I %
YResidential Value of Work$ /2-4 f Z/ — Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address SWa r fi ZZ
/5Z Sc add e r &Y Crr C,o^ M14 nL� -L
Contractor's Name n AfE &J';1?61Q.1.S Telephone Number (q01,�61 1?0(�
Home Improvement Contractor License#(if applicable) / 73.2 L/ S Email:
Construction Supervisor's License#(if applicable) ('�Cj' 7 D 7
2(vorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ m the Homeowner
I have Worker's Compensation Insurance
�
Insurance Company Name Cp0 t,'� I (✓ fin 1/J S ef,,D.
Workman's Comp. Policy# WZ 6 315620 R
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
e-side Weplacement Windows/doors/sliders.U-Value 3 y (maximum.32)#of windows Z—
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,,i.e.Historic,Conservation,etc.
***Note: Property kowner must sign Property Owner Letter of Permission.
A copy cR the Home Improvement Contractors License&Construetion Supervisors License is
require
SIGNATURE:
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Town of Barnstable *Permit or
� �(Z
Expires 6 months from issue date
`t1 Regulatory Services Fee
Richard V.Scali,Interim Director 4
JUL 1 Building Division
TOWN
Tom Perry,CBO,Building Commissioner
TO V1/ OF B� �s7^/lAB C b�C 200 Main Street,Hyannis,MA 02601
i www.town.barnstable.ma.us
„ Office: 508-8624038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number IF Z/ d 2,b p y
Property Address /3 2 Scs, e P/' ✓i-
[E Residential Value of Work$ 2 9, 6 6 6 — Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address p f Z
/ 3 Li Centervi lItt ►M A C2Co 7 L
Contractor's Name S o u--ThQrN 0-�. W t!U f0w S /A --PA)1-S0xJ--PA)/—SO Telephone Number t d 1—2z F5-,` 7 9,00
Home Improvement Contractor License#(if applicable) c? � Email:
Construction Supervisor's License#(if applicable) D /67o 7
�Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name N 1 A) Ll I ,
Workman's Comp.Policy#11
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement'Windows/doors/sliders.-U-Value . 30 (maximum.35)#of w' ows
#of doors:
_.❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
- Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliancee with other town department regulations,i.e.Historic,Consenation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission. -
A copy of the Home Improvement.Contractors License&Construction Supervisors License is
required.
L
SIGNATURE:
TAKEVIN D\Building ChangesNMRESS PERMIT)MRESS.doc
Revised 061313
+f a l Renewal RI Been¢ 3245
RE1�s8�VAL BY ANDERSEv 4 Littrx 4 171742t5
And
CT License a0634555
wtsoo trtAotrexr awl 26 Albion Road • Lincoln,Rl 02865 text Firm tt1237
n G Phone 866.563.2235•Fax 401.633.6602 retie 1 Tax ID?t<s-0566630
Southern New England Windows,LLC.d/b/a
OC� Renewal by Andersen of Southern New England ' s DEPOSIT CHKK
u Ilw� C OM WINDOW AND DOOR REMODELING AGREEMENT
suyer(%)Name. ✓l/F - SCI4 RTI_ Orin ofAgreeme= -7—./—/S—
Sums)SamAddrem OLy State.and lip Core.I P.O Box: /3 •CU409
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E-rw,Address:�l2Ff✓��I� b. 0 •`COM Hy,Crefephone Number. ..l -36y��OD Work Telephone Number:
Ct'r.L
Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern.New England W-indows,LLC d/b/a Renewal
by Andersen of Southern New England("Contractor".),in accordance with the terms and conditions described on the front and the reverse of
this agreement mid on the attached specification sheet(s)(collectively,thus Agreement"). 0 Historic ❑Condo ❑HOAT
TotaljobAmounc /`3 Esd ted�Stt2rv�nS Dztte: Method of Payment: O Check gash 0 Financed
Deposit Received(33%):
Credit Cards are accepted for deposit only-maximum 1I3 of the
Balance at Start of job Gam!` project cost(Precise see Credit Card Payment Form.)By signing this
Estmated Compl on Dace
Agreerneitf,you acknowledge that the Balance at Start of and the
Balance on Substantial �� _ ! (�/ Balance on Substantial Completion of job cannot be.rrade by credk
to omptedon of job(": AO(OVI card and must be matte by'personal check bank check or cash.
Buyer(s)agrees and understands that this Agreement constitutes the entire'understanding between the parties,and that
there are no verbal understandings changing'any of the terms of this Agreement.Buyers)acknowledges thatBuyer(s)
(1)has read this Agreement,understands the terms of this Agreement,and has received a.completed,signed,and dated
copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally
informed of Buyer's right to cancel this Agreement.DO NOT SIG9 THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
(Rhode Island Sales Only)Notice to Buyer:(I)Do not sign this Agreement if any of tbespaces intended for the agreed terms
to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign
it.(3)Yon may at any time payoff.the-full unpaid balance due under this Agreement,and in so doing you may be entitled to.
receive a partial rebate of the finance and insurance charges.'(4)The seller has no right to unlawfiallyenter your premises
or commit any breach of the peace to repossess goods purchased under this Agreement..(5)You may cancel this Agreement
if it has not b4en signed at the,Hain office or a branch office of the seller,provided you notify the,seller at his or her main
office or branch office shown is the Agreement by registered or certified mail,which shall be posted not later than midnight
of the third calendar day after the day on which the buyer signs the Agreement,excluding�Sunday and any holiday onwhich
regular mail deliveries are not made.Seethe accompanying notice of cancellation form for an esplauation of buyer's rights:
Buyer(s)received the consurner education materials provided by the Rhode Island Contractors Registration Board- (BWgs britiah)
Renewal dersen At Southern New England Buys s) Buyei(s)
By;
tgnatur of Product\Manager Signature- Signature "
CH/1�S fir ot/ _1TfF SwIf
Print Caine of Produa Manager Print Name Print Name.
YOU, THE BUYER(Sj, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE.THIRD
BUSINESS DAY AFTER THE DATE OFTHIS TRANSACTION.SEETHE ATTACHED NOTICE OF CANCELLATION FORMS
FOR AN EXPLANATION OF.THIS RIGHT:
NOTICE OF CANCELLATION NOTICE'OF CANCELLATION
Date of Transaction 7 / /S :You may cancel 1 Date of Transaction .You:may cancel
this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within
three business days from the.above date.If you cancel,any three business days from tfie above date.,If'you cancel,any
property traded'in,any payments made by you under the 1 property traded in,any payments made by;you under the
Contractor Sale,and any negotiable instrument executed I Contract or Sale,and any:negotiable instrument executed
by you will be returned within ten business days following t by-you will be returned within ten business days foUowirig
receipt by the Seller of your cancellation notice,and any. I receipt by the Seller of your cancellation notice,and any
security interest arising out of'the'transaction will be security interest arising out of the transaction *11 be
canceled.If you cancel,you must make available to the Seller I canceled.If you cancel,you must make available to the Seller
at your residence,in'substantially'as good condition as when. 1 at your residence,in Substantially as good condition as when
received,any goods delivered to you under this Contract or. I received,any goods delivered to you under this Contract or.
Sale;or you may,if you wish,comply with the instructions of I Sale;or you may,if you wish,comply with the instructions of
the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at-the
Seller's ex rise and risk.Ifyou do make the ggoods available X Seller's expense and risk.If you do make the ggoods available
to the Seller and the Seller does not pick them up within I to.the.Seller and the Seller does notpick'them:up within
twenty days of the'date of cancellation,you may retain or I twenty days of the date of cancellation,you may retain or:
dispose of the goods without any further obligation.If you 1 dispose of the goods without any further obligation.If you
fail to make the goods available to the Seller,or if you agree 1 fail to make the goods available to the Seller,or if you agree;
to return the goods to the Seller and fail to do so,then you I to return the goods to the Seller and fail to do so,then you
remain liable for`perfoirriance of all obligations under the remain liable for performance of all obligations under e
Contract.To cat cel this transaction,mail or deliver a signed I Contract-To cancel this transaction,mail or deliver a signed
and dated copy of this cancellation notice or any other 1 and dated copy of this cancellation notice or any other
Written notice.or send'a teleggram to Renewal byAndersen of I written notice,or send a telegram to Renewal by Andersen of
Southern New England at 26Albion Roadi Lincoln,RI 02865, I Southern New En��IIand at 2tl Albion Road,Lincoln,R102865
NOT LATER THAN MIDNIGHT OF 7�6 /5— I NOT LATER THt MIDNIGHT OF
(Date
t HEREBY CANCEL THISTRANSACTION. 1 HEREBY CANCELTHISTRANSACTION.
X
Buyer's SlgnitYPo_ prtnt Nam! Datt MOWN SIVVMUPo RIM Name Date
RbA Copy:White Buyer Copy:Yellow Buyer Copy:Pink'