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Page 3 O&M Inspection Report <br />VIII. Certification: <br />I hereby certify, under penalty of perjury, that the information presented in this report and <br />attachments is true and complete: <br />Signature of Property Owner or Other Responsible Party Date <br />Type or Print Name <br />Company Name <br />Address <br />Phone number: Email: <br />ATTY/AGR/2016.160/CENTRUM OWNERS ASSOCIATION - STMMA <br />REV: 06-22-16 JS <br />6.1.K. - Page 75