
<center>
<p><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: small;"><strong>DOG ASSESSMENT RECORD</strong></span></p>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<table style="width: 698px;" border="1" cellspacing="0" cellpadding="7"><colgroup><col width="153" /> <col width="136" /> <col width="16" /> <col width="16" /> <col width="40" /> <col width="250" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="153" height="23">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Name</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;AnimalName&gt;&gt;</strong></span></span></p>
</td>
<td width="136">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">No</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;ShortShelterCode&gt;&gt;</strong></span></span></p>
</td>
<td colspan="3" width="100">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">No Times Returned</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;NoTimesReturned&gt;&gt;</strong></span></span></p>
</td>
<td width="250">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Microchip No.</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;IdentichipNumber&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="153" height="24">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Most Recent Entry Date</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MostRecentEntry&gt;&gt;</strong></span></span></p>
</td>
<td colspan="3" width="197">
<p style="margin-bottom: 0cm;" ><span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Age on </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">09/02/10</span></span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;Age&gt;&gt;</strong></span></span></p>
</td>
<td colspan="2" width="304">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Area from</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;OriginalOwnerPostcode&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="153" height="24">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Sex</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;Sex&gt;&gt;</strong></span></span></p>
</td>
<td colspan="3" width="197">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Neutered?</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;Neutered&gt;&gt; &lt;&lt;NeuteredDate&gt;&gt;</strong></span></span></p>
</td>
<td colspan="2" width="304">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Breed</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;BreedName&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td colspan="3" width="334" height="34">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Colour</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;BaseColourName&gt;&gt;</strong></span></span></p>
</td>
<td colspan="3" width="334">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Distinguishing Features</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;Markings&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr>
<td colspan="6" valign="TOP" width="682" height="34">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Reason for entry</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;ReasonForEntry&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td colspan="3" width="334" height="62">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Public Comments</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><strong>&lt;&lt;AnimalComments&gt;&gt;</strong></span></span></p>
</td>
<td colspan="3" width="334">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">Private Comments</span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><strong>&lt;&lt;HiddenAnimalDetails&gt;&gt;</strong></span></span></p>
</td>
</tr>
</tbody>
</table>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<table style="width: 698px;" border="1" cellspacing="1" cellpadding="7"><colgroup><col width="155" /> <col width="145" /> <col width="159" /> <col width="81" /> <col width="79" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="155" height="7">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Vaccination Name</span></span></p>
</td>
<td width="145">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Date Required</span></span></p>
</td>
<td width="159">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Date Given</span></span></p>
</td>
<td width="81">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Wormed</span></span></p>
</td>
<td width="79">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Fleaed</span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="155" height="9">
<p  ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationName1&gt;&gt;</strong></span></span></p>
</td>
<td width="145">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationRequired1&gt;&gt;</strong></span></span></p>
</td>
<td width="159">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationGiven1&gt;&gt;</strong></span></span></p>
</td>
<td width="81">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="79">
<p   align="CENTER">&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="155" height="9">
<p  ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationName2&gt;&gt;</strong></span></span></p>
</td>
<td width="145">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationRequired2&gt;&gt;</strong></span></span></p>
</td>
<td width="159">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationGiven2&gt;&gt;</strong></span></span></p>
</td>
<td width="81">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="79">
<p   align="CENTER">&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="155" height="9">
<p  ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationName3&gt;&gt;</strong></span></span></p>
</td>
<td width="145">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationRequired3&gt;&gt;</strong></span></span></p>
</td>
<td width="159">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationGiven3&gt;&gt;</strong></span></span></p>
</td>
<td width="81">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="79">
<p   align="CENTER">&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="155" height="9">
<p  ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationName4&gt;&gt;</strong></span></span></p>
</td>
<td width="145">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationRequired4&gt;&gt;</strong></span></span></p>
</td>
<td width="159">
<p   align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;VaccinationGiven4&gt;&gt;</strong></span></span></p>
</td>
<td width="81">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="79">
<p   align="CENTER">&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="155" height="9">
<p  >&nbsp;</p>
</td>
<td width="145">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="159">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="81">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="79">
<p   align="CENTER">&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="155" height="8">
<p  >&nbsp;</p>
</td>
<td width="145">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="159">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="81">
<p   align="CENTER">&nbsp;</p>
</td>
<td width="79">
<p   align="CENTER">&nbsp;</p>
</td>
</tr>
</tbody>
</table>
<p style="margin-bottom: 0cm;"  align="CENTER">&nbsp;</p>
<p style="margin-bottom: 0cm; text-align: center;"  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>BEHAVIOUR ASSESSMENT</strong></span></span></p>
<center>
<table style="width: 696px;" border="1" cellspacing="0" cellpadding="7"><colgroup><col width="104" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="27" /> <col width="26" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="104">
<p >&nbsp;</p>
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<td width="104">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Friendly</span></span></p>
</td>
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<p >&nbsp;</p>
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</td>
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<td width="104">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Timid</span></span></p>
</td>
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<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Nervous</span></span></p>
</td>
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</tr>
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<td width="104">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Aggressive</span></span></p>
</td>
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<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Submissive</span></span></p>
</td>
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<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Bold</span></span></p>
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<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Unclean in bed</span></span></p>
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<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Destructive</span></span></p>
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<td width="104">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Food Proud</span></span></p>
</td>
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</table>
</center>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<table style="width: 696px;" border="1" frame="RHS" cellspacing="0" cellpadding="7"><colgroup><col width="613" /> <col width="54" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="613" height="9">
<p  align="RIGHT"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>DOG ASSESSMENT COMPLETED</strong></span></span></p>
</td>
<td width="54">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
</table>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<table style="width: 696px;" border="1" cellspacing="0" cellpadding="7"><colgroup><col width="207" /> <col width="144" /> <col width="144" /> <col width="143" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="207">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Medication</span></span></p>
</td>
<td width="144">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Frequency</span></span></p>
</td>
<td width="144">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Date Started</span></span></p>
</td>
<td width="143">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Treatments</span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalName1&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalFrequency1&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalStartDate1&gt;&gt;</strong></span></span></p>
</td>
<td width="143">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalTreatmentsGiven1&gt;&gt; / &lt;&lt;MedicalTreatmentsRemaining1&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalName2&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalFrequency2&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalStartDate2&gt;&gt;</strong></span></span></p>
</td>
<td width="143">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalTreatmentsGiven2&gt;&gt; / &lt;&lt;MedicalTreatmentsRemaining2&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalName3&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalFrequency3&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalStartDate2&gt;&gt;</strong></span></span></p>
</td>
<td width="143">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalTreatmentsGiven3&gt;&gt; / &lt;&lt;MedicalTreatmentsRemaining3&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalName4&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalFrequency4&gt;&gt;</strong></span></span></p>
</td>
<td width="144">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalStartDate3&gt;&gt;</strong></span></span></p>
</td>
<td width="143">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MedicalTreatmentsGiven4&gt;&gt; / &lt;&lt;MedicalTreatmentsRemaining4&gt;&gt;</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="143">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="143">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="143">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="143">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="207">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="144">
<p >&nbsp;</p>
</td>
<td width="143">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
</table>
<p style="margin-bottom: 0cm;" ><!-- pagebreak --></p>
<p style="margin-bottom: 0cm; page-break-before: always;"  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>ALL DOGS MUST BE KEPT A MINIMUM OF 7 DAYS</strong></span></span></p>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<center>
<table style="width: 712px;" border="1" cellspacing="0" cellpadding="7"><colgroup><col width="436" /> <col width="246" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="436" height="80">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>DOGS NAME</strong></span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-large;"><strong>&lt;&lt;AnimalName&gt;&gt;</strong></span></span></p>
</td>
<td width="246">
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>REF NO</strong></span></span></p>
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: x-large;"><strong>&lt;&lt;ShortShelterCode&gt;&gt;</strong></span></span></p>
</td>
</tr>
</tbody>
</table>
</center>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<center>
<table style="width: 712px;" border="1" frame="BELOW" rules="GROUPS" cellspacing="0" cellpadding="7"><colgroup><col width="342" /> <col width="342" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>7 DAY ASSESSMENT</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>READY FOR REHOMING YES/NO</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>COMMENTS</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>SIGNATURE OF SUPERVISOR</strong></span></span></p>
</td>
<td width="342">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>DATE</strong></span></span></p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>14 DAY ASSESSMENT</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>READY FOR REHOMING YES/NO</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>COMMENTS</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>SIGNATURE OF SUPERVISOR</strong></span></span></p>
</td>
<td width="342">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>DATE</strong></span></span></p>
</td>
</tr>
</tbody>
</table>
</center>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<center>
<table style="width: 712px;" border="1" frame="BELOW" rules="GROUPS" cellspacing="0" cellpadding="7"><colgroup><col width="342" /> <col width="342" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>MANAGERS REPORT</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>REHOME</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>OTHER</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>COMMENTS</strong></span></span></p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p >&nbsp;</p>
</td>
<td width="342">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="342">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>MANAGERS SIGNATURE</strong></span></span></p>
</td>
<td width="342">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>DATE</strong></span></span></p>
</td>
</tr>
</tbody>
</table>
</center>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<center>
<table style="width: 698px;" border="1" frame="BELOW" rules="GROUPS" cellspacing="0" cellpadding="7"><colgroup><col width="93" /> <col width="523" /> <col width="40" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="93">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Socialising</strong></span></span></p>
</td>
<td width="523">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Comment</strong></span></span></p>
</td>
<td width="40">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Sign</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Dogs</strong></span></span></p>
</td>
<td width="523">
<p  align="CENTER">&nbsp;</p>
</td>
<td width="40">
<p  align="CENTER">&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Bitches</strong></span></span></p>
</td>
<td width="523">
<p  align="CENTER">&nbsp;</p>
</td>
<td width="40">
<p  align="CENTER">&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Puppies</strong></span></span></p>
</td>
<td width="523">
<p  align="CENTER">&nbsp;</p>
</td>
<td width="40">
<p  align="CENTER">&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Cats</strong></span></span></p>
</td>
<td width="523">
<p  align="CENTER">&nbsp;</p>
</td>
<td width="40">
<p  align="CENTER">&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p >&nbsp;</p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="93">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Training</strong></span></span></p>
</td>
<td width="523">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Comment</strong></span></span></p>
</td>
<td width="40">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Sign</strong></span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Heel</strong></span></span></p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Sit</strong></span></span></p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Down</strong></span></span></p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Stay</strong></span></span></p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Come</strong></span></span></p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>Leave</strong></span></span></p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="93">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>No</strong></span></span></p>
</td>
<td width="523">
<p >&nbsp;</p>
</td>
<td width="40">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
</table>
</center>
<p style="margin-bottom: 0cm;" ><!-- pagebreak --></p>
<p style="margin-bottom: 0cm;" >&nbsp;<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: medium;"><strong>&lt;&lt;AnimalName&gt;&gt; &lt;&lt;ShortShelterCode&gt;&gt;</strong></span></p>
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>ANIMAL CENTRE DOG VETERINARY RECORD</strong></span></span></p>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
<table style="width: 696px;" border="1" cellspacing="0" cellpadding="7"><colgroup><col width="57" /> <col width="550" /> <col width="45" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="57">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Date &amp; Vet</span></span></p>
</td>
<td width="550">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Comment</span></span></p>
</td>
<td width="45">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Sign</span></span></p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
</td>
<td width="550">
<p >&nbsp;</p>
</td>
<td width="45">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="57">
<p >&nbsp;</p>
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</td>
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<p >&nbsp;</p>
</td>
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<p >&nbsp;</p>
</td>
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</td>
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</td>
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</td>
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<p >&nbsp;</p>
</td>
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</td>
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<p >&nbsp;</p>
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<p >&nbsp;</p>
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<p >&nbsp;</p>
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</td>
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</table>
<p style="margin-bottom: 0cm;" ><!-- pagebreak -->&nbsp;</p>
<p style="margin-bottom: 0cm; page-break-before: always;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>ANIMAL CENTRE WEIGHT SHEET</strong></span></span></p>
<p style="margin-bottom: 0cm;" ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"> kg</span></span></p>
<table style="width: 1044px;" border="1" cellspacing="0" cellpadding="7"><colgroup><col width="87" /> <col width="100" /> <col width="100" /> <col width="623" /> <col width="62" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="87">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Date</span></span></p>
</td>
<td width="100">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Weight</span></span></p>
</td>
<td width="100">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Weight Change</span></span></p>
</td>
<td width="623">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Comment</span></span></p>
</td>
<td width="62">
<p  align="CENTER"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Sign</span></span></p>
</td>
</tr>
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<td width="87">
<p >&nbsp;</p>
</td>
<td width="100">
<p >&nbsp;</p>
</td>
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<p >&nbsp;</p>
</td>
<td width="623">
<p >&nbsp;</p>
</td>
<td width="62">
<p >&nbsp;</p>
</td>
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</td>
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</td>
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<p >&nbsp;</p>
</td>
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<p >&nbsp;</p>
</td>
<td width="62">
<p >&nbsp;</p>
</td>
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<td width="87">
<p >&nbsp;</p>
</td>
<td width="100">
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</td>
<td width="100">
<p >&nbsp;</p>
</td>
<td width="623">
<p >&nbsp;</p>
</td>
<td width="62">
<p >&nbsp;</p>
</td>
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<td width="87">
<p >&nbsp;</p>
</td>
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</td>
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</td>
<td width="623">
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</td>
<td width="62">
<p >&nbsp;</p>
</td>
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</td>
<td width="100">
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</td>
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<p >&nbsp;</p>
</td>
<td width="623">
<p >&nbsp;</p>
</td>
<td width="62">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="87">
<p >&nbsp;</p>
</td>
<td width="100">
<p >&nbsp;</p>
</td>
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<p >&nbsp;</p>
</td>
<td width="623">
<p >&nbsp;</p>
</td>
<td width="62">
<p >&nbsp;</p>
</td>
</tr>
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<td width="87">
<p >&nbsp;</p>
</td>
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<p >&nbsp;</p>
</td>
<td width="623">
<p >&nbsp;</p>
</td>
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<p >&nbsp;</p>
</td>
</tr>
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<td width="87">
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</td>
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<p >&nbsp;</p>
</td>
<td width="623">
<p >&nbsp;</p>
</td>
<td width="62">
<p >&nbsp;</p>
</td>
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</tbody>
</table>
<p  ><br /><!-- pagebreak --></p>
<p  >&nbsp;</p>
<table style="width: 1044px;" border="1" rules="COLS" cellspacing="0" cellpadding="7"><colgroup><col width="141" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="15" /> <col width="14" /></colgroup>
<tbody>
<tr valign="TOP">
<td width="141" height="8">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><strong>&lt;&lt;MostRecentMonthEntry&gt;&gt; </strong></span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">1</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">2</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">3</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">4</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">5</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">6</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">7</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">8</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">9</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">10</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">11</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">12</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">13</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">14</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">15</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">16</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">17</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">18</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">19</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">20</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">21</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">22</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">23</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">24</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">25</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">26</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">27</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">28</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">29</span></span></p>
</td>
<td width="15">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">30</span></span></p>
</td>
<td width="14">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">31</span></span></p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Diarrhoea</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Blood in motions</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Coughing</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Bleeding pads</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="10">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Vomit</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="10">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="10">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="10">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Walked</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Bathed</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Groomed</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Vet visit</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
<tbody>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p ><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Comment</span></span></p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="9">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="7">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="7">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="7">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="7">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
<tr valign="TOP">
<td width="141" height="6">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="15">
<p >&nbsp;</p>
</td>
<td width="14">
<p >&nbsp;</p>
</td>
</tr>
</tbody>
</table>
<p  style="margin-bottom: 0cm;" >&nbsp;</p>
<p style="margin-bottom: 0cm;" >&nbsp;</p>
</center>
