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Home My WebLink About1000-97.-7-26.6 TOWN OF S UTH LD Rental Permit 1291 Owner: Jonathan Ellinghaus , Joy Ellinghaus Occupied as: Single Family Dwelling Located at: 840 Little Neck Rd Cutchogue 97.-7-26.6 Maximum Permitted Occupancy: 6 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for Oe bi-annual inspection. Issued: 04/14/2025 _. Expiration: 04/14/2027 co a Enf ment Official 41 This Notice must be posted by the main entrance at all times � TOWN OF SOUTHOLD—BUILDING DEPARTMENT T ovvm Hall Amex 54375 Main Road P. 0. Box- 1179 Southold,NY 11971 09, Telephone(631)765-1802 Fax(631)765-9502"r��:i��m�� 1y`a.111 1 P%L I.. %,#w aiw I nr r 1.,1w.r%I IyI• C'OArt /"A_il��.a:�... ....,...,a G� ..._.-�..._.l ....�....a_ � 1.�. ..��,...i _-.. Section A. r3, Property Information: Rental Property Address Tax Map Number: 1000 SECTION 1 -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: J, Property Owner Legal Address: Property Owner Mailine Address: kl.dFIHUL Utr Lrle sdrrle ds RerlLdl rrUPerLYAUUressJ 12 r yq F s tw R Ie eU1h0(1e NumUCr (SI: IJdVIIffIC CVC(IIIYe at'(te(Re(I(.»V wn q Property Owner Email Address: I ryage 3 o 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, 1:3, U);the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application. Aririanrhim ' Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit: _, (-'(7 Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: " �� C �'�� '�j r� ''r ►3� (..r .A- i/'OD`•/dry 1, ✓ U ,,...N V, Y, b roo,/� Ilk-k- I+",AI+ 4..A C."' SECTION C, II�JI LV 1IV1�• Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, a licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Pravantinn Rifilriino Unria Uartifiratinn is ranmrarf ctatino that tha nrnnarhv whirh is tha aihiart of the rental permit application is in compliance with all of the,provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code CouncV. I am requesting a fire safety inspection to be performed by a Code Enforcement Official frnm tha Tnwn of crsiithr!r Li i am submizzing a compiezea i own or.,)outnoia cerzincazion rorm rrom a ncensea architect or a licensed professional engineer. Page 3 of 4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) .1 '��. m�� ' � � � �� i� " �� certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal ...L.I.n.•, ......I1 ..w++*N,.ry..rn+wv A-Ft.,..T..—., .,,;11 +k.. -1,1...— d...,,. .�,t.� riire. nn4•bn �11 applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto.. 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days s to any change to the information Property Owner's Name: ..... m [1 ;�°� d�E ° S,� �...,,,.... Property Owner's Signature; Sworn to before me this day of k oyc,/Yt &` 20a q Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Page 4 of 4 G Commission Expires April 14, 2 0Q O of 0 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 ?7- 7-1;1-6- (0�-" INSPE�TION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL ) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: 4 - /,f i(�ce,"ou;.tAAJ--e-, ors RATE INSPECTOR fat S TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 lv N P E(C"T 10 N [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [4"'R ENTAL REMARKS: S'm 4a Aj. WeMoVt `OW( 6/a Ve 44 G4 a, 1nS � ��.hoh Gatit ha .din GOMII�o GZd�.�- a� A,,k 49L At gt4(4 OV2g�- ;lh 1 a2/vl ,`I a , ien ---------- DATE INSPECT Town Hall Annex Town Of Southold 54375 Main Road cn Rental Inspection Report PO Box 1179 " Southold NY 11971-1179 Tel: 631-765-1802 SCTM Owner# k 1 Vow_ ....._. _ Date . ...� .n�. C , . ....... _w._w �w�_._ ��.�.. ,.� .,�. ..�� .Phone..,. _.. . �.. . �w . .._. _� a� �� S. -.. .' ............. m.M.... 'Hamlet lrsl elctor Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) ® Carbon Monoxide Detectors._... .... .... .._ .._�w.. .. _ ._. ...._. ............. FireExtinguishers Exits s ) �Bedrooms.....m_ 1 .._.....2 .. �..._�. ._.3�._� ....,. __..4�._ . . ....._5.... 6 w._... , Smoke Detectors Egress � �.�_..s,_. �.. . .r. . .. __ . .. _ . _ �... .... _... . .._.. ... .......... n. ..... ... . .�..... m, _ ,,.. ._m ._... _ . e . Building Systems Maintained &Operational Condition of Property Heating Building interior d �...�. .._ �. _.,...... �.. _ .... ._aw_. Hot water Building exterior Electrical 'Property clean ma intained &safe 6 Mechanical Handrails &guards install .led &secure Pool Safety !Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed ySelf closing latching. � ...�..... . ....,�.._.�W� _ _.. gates � Pool fence to code requirements ....�.a _r �l! items_ ....sent 1.. .... ....._�..�...� Prior Rental _.._ .. ...__..,...�..... ., a. . ... CO s for all re Comments ... . .. . ,�w... ,. .. ...w ._ TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOTC, ------------------- FORMER OWNER N E ACR. —A v S W TYPE OF BUILDING v RES v SEAS. VL. FARM COMM. CB. MILS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 3 F ,;�-:`,i��-v -7 AF 2, 5000 31, /Pg 4 4 00 /moo 50 ;7 4L4 L ?n"'For Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowlond DEPTH House Plot BULKHEAD Total :OLOR � TRIM r rt I E t ' e € I 47.-7-26.6 1l06 M. Bk K-- - € i z i { S € Extension �- �e_ _ y:t I "2, _ r €.... �t i I Extension I _F Extension 113 fFoundation �� Bath �'n7 7— Porch Dinette Basement a/v,- _ �� " i Fioors 3<_ �Ext. Walls r Interior Finish L . Breezeway Fire Place i �- Heat DR tia ra e Type Roof i r I a Rooris 1st Floor Patio i � !� � � k� �! Recreation Room Rooms 2nd Floor - I O. B. i - ;Dormer Driveway ` ►rev`, ` ::"�� j�r` 'j .e,.�uz sue.G� .f•1.6e e�.�f v^'p _,,,-�J - _. 1 FOAM NO,4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No. Z1.QPPA . . . . . . . , , Date . . . , . .4PAgrY. .1,B . . . . . . . . . . . . . 1982, THIS CERTIFIES thatthe,buulding . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . , . . . . . . . , . Location of Property 04.0 , . ,, , „ „ „ �,�Y�t)a„DJ�¢Jt„It9ftd Cutcl�oguo „ House No, Street Nam%t County Tax Map No, 1000 Section .Q97. . , . . . . .Block 07. , „ . , , . . . , . , ,Lot 026.b, « w . , .« « Subdivision .LittIq .0Pc.% ,Vrgpartie,Q , . . ,Filed Map No, �Q44. . . .Lot No. ,. . . . . . , , , . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . 4Q➢t,o„ ibor. .21 . . . . 19 41 pursuant to which Building Permit No, , 1 12.89 T dated . . S,e,P t D tn.b,Q r, 2.9, , , , , , , , . . , . 19 .$ l ,was issued, and conforms to all of the requirements of the applicable provisions of the law,The occupancy fdr which this certificate is issued is , , . , . , , . . . , . .4 pr.i,�r4tP. .v H-fam��.Y. .�Wo,��,trip'.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . The certificate is issued to . . , , Anthony Jar zaUkowBki & wife (owner,yfars av:iariaiuiJ . . . . . . . . . . . . . . . . . of the aforesaid building, Suffolk County Department of Health Approval .11 -SA-a0.,. ,'t/, J?AQ4 R,q Q9rA .4 , Vi 4. UNDERWRITERS CERTIFICATE NO. . . .. . N. 154614.6.1. „ . . A . , . . , » » « „ „ « , . . « , . Bulkling�IrLs Rev.1101 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bullding inspector Town Hall Southold,N.Y. Certificate Of Occupancy No2Uq$`I. . . . . . . . . . . Date . . . . JulY. A.. .. . . . .. . . . .. . . . .. 19 .$5 THIS CERTIFIES that the buUding . . . . . . . . .. . . . . . . ... . . . . . . . . . . . Location of Property O .�T�tlp,NeG4.&q% . . . . . 4'1?tc�lRB11!?.,. .Nr Y.•. . . , House No, &ree( Hamlet County Tax Map No. 1000 Section . . .fl97 . . . . .Block . .a7. „ . . . . . . . . .Lot Subdivision . M/o, Pittle Neck Propertied Map No. 6fl48. —Lot No. . . . .6. . . . . . .. conforms substantially to the Application for Building permit heretofore filed in this office dated ,July, A$,, . , , , , , , 198A .pursuant to which Building Permit No. 15098 Z... dated . . .JAY.1 .. . . . . . . . . . . . . . .. 19 86 ,was Issued,and conforms to all of the requirements of the appilcable provisions of the law. The occupancy for which this certificate is issued is . .. . . . . . . deck, addition to existing one, family dwelling . . . . . . . . . . . . . . . . . . . . . . The certificate is Issued to . .AXLtAQ4Y. A .9VS.1.Y.r) ,AA " k QV1 A . . . . . . . . . . . . . . . . . . . . . 10"ar,4 RN-1 V of the aforesaid building. Suffolk County Department of Health Approval .. . . . . . . . . . . . . .IN/A . . . . . . .. . . . . . . , . . . . .. . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . .„ NIA . . . . . . . . h. . „ . w . . . . . . . . . . . .. . . . . . . . . . . . Building Inspector Rev,1181 6 FORM NO. 4 TOWN OF SOUTHOLD BUZLD1NG DEPARTMENT office of the Building Inspector Town Ball Southold, N.Y. CSRTZF=CATB OF OCCUPANCY No Z-22967 Date MY 104_1994 THIS CERTIFIES that the building ACCESSORY Location of Property 840 LITTLE NECK ROAD CUTCH2a2E NEW YORR House No. Street Hamlet County Tax Map No. 1000 Section 97 Block 7 Lot 26.6 Subdivision __-Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 24 1994 purau,ant to which Building Permit No. 2204E-Z dated MAY 9 1994 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY SHED "AS BUILT" The certificate is issued to PETAR BOGOVIC o (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ,I ding Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31185 bate: 10 05 05 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property: 640 LITTLE NECK RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473669 Section 97 Block 7 Lot 26.6 Subdivision -- Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 2 2005 pursuant to which Building Permit No. 31111-Z dated MAY . S, 2005 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ALTERATION & GARAGE ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RICHARD & DONNA SMITH ........,..,....._,.�.�...-..,....... (OWNER) ....,....,...... of the aforesaid building, SUFFOLK COUNTY DEPARTMIENT OF HEALTH APPROVAL N A ELECTRICAL CERTIFICATE NO. 2070377 09 0OLOS, PLUFMRRS CERTIFICATION DATED r Auth ized Signature Rev. 1/81 Town of Southold Annex xWµ 7/9/2ry013 P.O. Box 1179LW - 54375 Main Road Southold,New York 11971 7.�..,.:, CERTIFICATE OF OCCUPANCY No: 36338 Date: 7/9/2013 THIS CERTIFIES that the building 1N GROUND POOL Location of Property: 840 Little Neck Rd,Cutchogue, _.,. ..,.. SCTM#: 473889 Sec/Block/Lot: 97..7-26,6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 3/7/2013 pursuant to which Building Permit No. 37862 dated 3/13/2013 was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: arCm*Lsmory v- oymLs urplaa)ltlAi? _ e e cad to "�S ,:,5 1. a lire, The certificate is issued to Marks Jr, Robert& Marks,Karen of the aforesaid building, SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO, 37862 .. 5/28/13°.... PLUMBERS CERTIFICATION DATED . lor td Sign ut c Town of Southold Annex 7/9/2013 4" P.O.Box 1179 54375 Main Road " ► ;°� Southold,New York 11971 CE,WrIFICATE OF OCCUPANCY No: 36338 Date: 7/9/2013 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 840 Little Neck Rd,Cutchogue, SCTM#: 473889 SecBiock/Lot: 97.-7-26.6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 3/7/2013 pursuant to which Building Permit No. 37862 dated 3/13/2013 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory it) qpd_ rvinanl ool fenced to coca applied-for. The certificate is issued to Marks Jr, Robert&Marks, Karen .._.. ... ,, ....... (OWNER) .. _w_. _, . ..... ............. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 3 / 8/13 PLUMBERS CERTIFICATION DATED FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold,N.Y. Certificate Of Occupancy No7M04. . . . . . . . . . . Date . . . . JulY. .22.. . . . . . . . . . . . . . . . . .I 19 .86 THIS CERTIFIES that the building . , deck addition, , , , , , , , , , , , , , , , , , , , , , , Location of Property , , , , , Cu drogue,, N;Y.. , , House No. StreetHamlet County Tax Map No. 1000 Section . . . . . . . .Block , .07, . . . . , . , . . .Lot . .266 . Subdivision . MIo, Little Neck Properti.piled Map No. 60`�$. . . .Lot No. . . . .6. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated , July_ 18,, , , . , . 198.6 pursuant to which Building Permit No. 5098 Z dated . . . : :AY. 18.% . . „ „ . „ , . . , , „ , „. 19 86 ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . deck, addition, . . existing one family dwelling The certificate is issued to . .A-DthQ4y. &. ,Fyv?y4 jjaj,? ,kova i (0W"er, of of the aforesaid building. Suffolk County Department of Health Approval . . . , , . . . „ , . . . a .N/A „ , , , , , , , , „ „ ,. , , , , , , , w , UNDERWRITERS CERTIFICATE NO. . . . . „ . , . . , . . . . . . . . . . . . .NJA . . . . , . , , , , , Y-IX „ . . . . . . . . . . . . . . . . . Building Inspector Rev.1181 _ _ ` rn n t �F E - s �4a 3 _ A sy z. t 7 8 PTO`n .-'jNsPE F O DAnO ;GUPAN3 ON as Ne Rouc e_ g TE (�?�? r - _ Ni�3S'4" . 4 - - " IMM, .._ tom T - 0�wu t pop FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OC-LVPANCY No Z-22987 Date MAY 10, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 840 LITTLE NECK ROAD CU , N39W YORK House No. Street Hamlet County Tax Map No. 1000 Section 97 Block 7 Lot 26.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 24 1994 ursuant to which Building Permit No. 22048-Z dated MAY 9 1994 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY SHED "AS BUILT" The certificate is issued to PETAR BOGOVIC (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A lei'dild-ing Inspector Rev. 1/81 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z1.0856 . . . . . . . . . Date . . . . . .January. .18 . . . . . . . . . . . . . 1982. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property . .8 Q . . . . . . . . LAt;tlA ,Alecic. ,Itgad. . . . . . . . . . . Cutchmue House No. Street � Hamlet County Tax Map No. 1000 Section .Q 9 7. . . . . . . .Block 07. . . . . . . . . . . .Lot 0?6,6. . . . . . . . . . . Subdivision .L:Ltt]..os .19p.c.k .rrAp,4rtiQ4 . . . .Filed Map No. �OP. . . .Lot No.6. . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated 8 1 pursuant to which Building Permit No. 1 dated . . ;3APt Qwb.Qr. 49 . . . . . . . . . . . 19 .8, 1 ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . . . .4 .pr.-tv(Ato. .� � -.f.�i:�2�.Y. .dw AI ,nka•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . , 0.ntlion. . .y .Jarzabko;rrski & wife . . . . . . . . . . .fawner,; . . . »trer�rxtl . . . . , . . . . . » . . . , . , . . » . of the aforesaid building. Suffolk County Department of Health Approval .1.1 -SQ-88.,. A/. 3�lg�,. Fc�qep� ,/� ., Ui;Ila UNDERWRITERS CERTIFICATE NO. . . . . . N. .546GE 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building l.nspec or Rev.1181 FORK( NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31185 Date: 10 05 05 THIS CERTIFIES that the building ADDITION & .ALTERATION Location of Property: 840 LITTLE NECK RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 97 Block 7 Lot 26.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 2 2005 pursuant to which Building Permit No. 31111-Z dated MAY S 2005 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ALTERATION & GARAGE ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RICHAR.D & DONNA SMITH (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTNOT OF HEALTH APPROVAL m�N/A EIJ?CTRICAL CERTIFICATE NO. 2070377 09 08 05 PLUXBRRS CERTIFICATION DATED - N/A r Autho ized Signature Rev. 1/81 Aq �. IN 06 40 t � a F Y i CiAdkoe, M3's