Affidavit and Revenue Certification Chimp Haven, Inc. Caddo Parish Keithville, LA

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1 / / / / Affivit Revee Certifiti Chi Hve, I. C Prih Keithville, LA ANNAL WRN FINANCL TATNT AND CRTIFICATIN F RN $0,0 R L (if lible) The l wr fiil tteet re reqire by Lii Revie ttte 24:14 t be file with the Leiltive Aitr withi 90 y fter the le f the fil yer The ertifiti f revee $0,0 r le, if lible, i reqire by Lii Revie ttte 24:1(l)(1)()(i). **************************************************************************************************** Perlly e ere befre the erie thrity, Li Bret ty wr, ee y tht the fiil tteet herewith ive reet firly the fiil iti f Chi Hve, I. f eteber 0, 2010, the relt f erti fr the yer the ee, i re with the bi f ti eribe withi the yi fiil tteet. (Clete if lible): I iti, Li Bret, wh, ly wr, ee y tht Chi Hve, I. reeive $0,0 r le ($-0-) i revee ther re fr the yer ee eteber 0, 2010, rily, i t reqire t hve it fr the revily etie yer. ffier itre -. wr t bribe befre e thi / y y f /h f 20f /. :- I R.TIBBIT, Nfry Pblle NTAR PI IRI IP " C*tPrih,lll NTARY PBLIC y Clkxi I Fr % Ntry ID#7181 **************************************************************A**i****************ik******************ft***ft ffier' Ne C!f'CyLL- ffier' Title AAli' tity Are 7 kri!.:. P]?,. jh. ' er rvii f tte lw, thi rert i Dblir.Ph/Fx/-il( )?, -T7 C -y,-).-? et Ay f the rert h bee bitte t X i \ C rf t=\ theetitytherrhtebliffiil The rert i vilble fr bli ieti t the B ('i *1/-'7/( W H L fit f) Re ffie fthe Leiltive Aitr, where rrite, t the ffie f the rih lerk f rt. yijhhjx Lv} iaa*y6% ' Relee Dte

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