Document:

Exhibit 10.7

 

QUAD/GRAPHICS, INC.

 

DIVIDEND/DISCOUNT
DEFERRED

 

COMPENSATION
PLAN

 

AS
AMENDED AND RESTATED EFFECTIVE DECEMBER 31, 2008

 

 

TABLE OF CONTENTS

 

	
   

  	
   

  	
  Page

  
	
   

  	
   

  	
   

  
	
  Section 1.

  	
  Purpose:

  	
  1

  
	
   

  	
   

  	
   

  
	
  Section 2.

  	
  Definitions:

  	
  1

  
	
  2.1

  	
   

  	
  “Account”

  	
  1

  
	
  2.2

  	
   

  	
  “Board”

  	
  1

  
	
  2.3

  	
   

  	
  “Code”

  	
  1

  
	
  2.4

  	
   

  	
  “Company”

  	
  1

  
	
  2.5

  	
   

  	
  “2005 Amendment”

  	
  2

  
	
  2.6

  	
   

  	
  “Participant”

  	
  2

  
	
  2.7

  	
   

  	
  “Plan”

  	
  2

  
	
  2.8

  	
   

  	
  “Non-Tax Dividend”

  	
  2

  
	
  2.9

  	
   

  	
  “Termination of Employment”

  	
  2

  
	
   

  	
   

  	
   

  	
   

  
	
  Section 3.

  	
  Account:

  	
  2

  
	
  3.1

  	
   

  	
  Account

  	
  2

  
	
  3.2

  	
   

  	
  Additions

  	
  3

  
	
  3.3

  	
   

  	
  Subtractions

  	
  3

  
	
   

  	
   

  	
   

  	
   

  
	
  Section 4.

  	
  Vesting:

  	
  3

  
	
   

  	
   

  	
   

  
	
  Section 5.

  	
  Distribution:

  	
  4

  
	
  5.1

  	
   

  	
  Options Exercised Prior to January 1, 2009

  	
  4

  
	
  5.2

  	
   

  	
  Options Exercised After December 31, 2008

  	
  4

  
	
  5.3

  	
   

  	
  Expired Options and Other Forfeitures

  	
  4

  
	
   

  	
   

  	
   

  	
   

  
	
  Section 6.

  	
  Amendment and
  Termination of Plan:

  	
  4

  
	
   

  	
   

  	
   

  
	
  Section 7.

  	
  Claims
  Procedure:

  	
  4

  
	
  7.1

  	
   

  	
  Initial claim for benefits

  	
  5

  
	
  7.2

  	
   

  	
  Appeals

  	
  5

  
	
   

  	
   

  	
   

  	
   

  
	
  Section 8.

  	
  Miscellaneous
  Provisions:

  	
  6

  
	
  8.1

  	
   

  	
  Administration

  	
  6

  
	
  8.2

  	
   

  	
  Set off

  	
  6

  
	
  8.3

  	
   

  	
  Continuation of employment

  	
  6

  
	
  8.4

  	
   

  	
  Contractual Liability

  	
  6

  
	
  8.5

  	
   

  	
  Benefits not assignable

  	
  7

  
	
  8.6

  	
   

  	
  Payments to minors and others

  	
  7

  
	
  8.7

  	
   

  	
  Code Section 409A

  	
  7

  
	
  8.8

  	
   

  	
  Construction

  	
  7

  

 

i

 

QUAD/GRAPHICS, INC.

DIVIDEND/DISCOUNT
DEFERRED COMPENSATION PLAN

 

Section 1.   Purpose:

 

Prior to 2005, the Company issued discounted stock options to a select
group of management or highly compensated employees.  As a result of the initial interpretation by
the Internal Revenue Service concerning the application of Code Section 409A,
the Company desired to split the benefits provided through the discounted
options into two separate arrangements: 
fair market value options and this Plan. 
As a result, the Company adopted the Plan to provide a means by which
the dividend and discount features which would otherwise have been provided under
the stock option program could be provided to eligible employees.  The final regulations for Code Section 409A
require aggregation of the Plan with the fair market value options for purposes
of compliance with Code Section 409A, necessitating the substantive
revisions in this restatement.  The Plan
is intended to be a nonqualified deferred compensation plan under Code Section 409A.  The Plan is intended to be an unfunded plan
maintained primarily for the purpose of providing deferred compensation
benefits for a select group of management or highly compensated employees under
Sections 201(2), 301(a)(3) and 401(a)(1) of the Employee
Retirement Income Security Act of 1974.

 

Section 2.   Definitions:

 

As used in the Plan, unless otherwise indicated by the context:

 

2.1          “Account”
shall mean, with respect to each Participant, each separate account to be kept
for each Participant as described in Section 3.

 

2.2          “Board” shall mean the Board of Directors of the
Company.

 

2.3          “Code” shall mean the Internal Revenue Code of
1986, as amended.

 

2.4          “Company” shall mean Quad/Graphics, Inc.

 

1

 

2.5          “2005
Amendment” shall
mean the amendment to stock option agreements adopted by the Board on December 16,
2005 which became effective for a Participant upon the Participant’s written
consent filed with the Company no later than December 31, 2005.

 

2.6          “Participant” shall mean an employee or director of
the Company or any affiliate thereof who (i) on December 31, 2005 had
a pre-2005 stock option agreement from the Company for which the 2005 Amendment
was effective, or (ii) on or after December 16, 2005 but prior to January 1,
2008 was granted options by the Company.

 

2.7          “Plan” shall mean the Quad/Graphics, Inc.
Dividend/Discount Deferred Compensation Plan as herein set out or as duly
amended.

 

2.8          “Non-Tax
Dividend” shall
mean a dividend paid by the Company to its shareholders other than a “tax
distribution dividend” which is required to be paid by the Company to shareholders
pursuant to the terms of the applicable shareholders’ agreement related to
taxes passed through to shareholders as a result of the Company’s S corporation
election under Code Section 1362.

 

2.9          “Termination
of Employment”
shall mean a “separation from service” as defined under the default rules of
the applicable regulations for Code Section 409A.

 

Section 3.   Account:

 

3.1          Account: 
The Company shall establish one or more book reserve Accounts on behalf
of each Participant.  A separate Account
shall be established for each separate grant of options to the Participant
prior to January 1, 2008.  Such
Accounts shall be adjusted pursuant to the provisions of Sections 4.2 and
4.3 with respect to the options attributable to the grant reflected in such Account.  The Plan shall not apply to any options
granted on or after January 1, 2008.

 

2

 

3.2          Additions: 
Each Account for a Participant shall be credited as follows:

 

3.2.1        For each Account
attributable to a pre-2005 stock option grant from the Company for which the
2005 Amendment is effective, as of December 31, 2005, the Account shall be
credited with the sum of a dividend equivalent and a discount replacement.  The dividend equivalent shall be equal to $2.00
(to reflect the $2 per share dividend paid on January 3, 2005) times the
number of shares underlying the outstanding options on December 31,
2005.  The discount replacement shall be
equal to the aggregate amount by which the exercise price for the outstanding
options on December 31, 2005 increased due to the 2005 Amendment.

 

3.2.2        As any Non-Tax
Dividends are paid, the Account shall be credited with a dividend equivalent
equal to the dollar amount of the per share Non-Tax Dividend times the number
of shares underlying options outstanding on the dividend record date for the
Non-Tax Dividend.

 

3.2.3        In the event all or a
portion of the options are exercised prior to 2009, from such date until the earlier
of the date of distribution in Section 5 or December 31, 2008, the
portion of the Account attributable to such exercised options shall be credited
with an interest equivalent based on the rate earned in the stable asset
account of the Quad/Graphics Personal Enrichment Plan.

 

3.2.4        An Account shall be
credited with the amount designated by the Board from time to time.

 

3.3          Subtractions: 
Each Account for a Participant shall be debited by the amount of any
distributions and forfeitures in Section 5.

 

Section 4.   Vesting:

 

As of any date, the vested percentage of an Account is based on the
percentage of the exercisable options attributable to the grant reflected in
such Account.  For this purpose, the
percentage of exercisable options is a fraction, the numerator of which is the
sum of exercisable options on the applicable date and any options from the same
grant which were previously exercised after December 31, 2005, and the
denominator of which is the number of options in the grant on the later of the
original grant date or December 31, 2005. 
For an Account from which no distribution has previously been made, the
vested portion of the Account is the vested percentage of the Account
value.  For an Account from which a
previous distribution has been

 

3

 

made under Section 5, the vested portion of the
Account is an amount (“X”) determined by the formula X = P(AB + D) – D, where P
is the vested percentage, AB is the Account value, and D is the amount of the
previous distributions from the Account.

 

Section 5.   Distribution:

 

5.1          Options
Exercised Prior to January 1, 2009:  With respect
to options that were exercised prior to January 1, 2009, the vested
portion of a Participant’s Accounts attributable to such options shall be paid to
the Participant in a cash lump sum amount in January 2009.

 

5.2          Options
Exercised After December 31, 2008:  With respect
to options that are exercised after December 31, 2008, the vested portion
of a Participant’s Accounts attributable to such an option shall be paid to the
Participant in a cash lump sum amount on the date of exercise of the option.

 

5.3          Expired
Options and Other Forfeitures:  With respect
to any options that expire without being exercised, the portion of a
Participant’s Accounts attributable to such options shall be forfeited, whether
otherwise vested or nonvested.

 

Section 6.   Amendment and Termination of Plan:

 

The Board may amend any provision of the Plan or terminate the Plan at
any time; provided, that in no event shall such amendment or termination reduce
any Participant’s Accounts as of the date of such amendment or termination, nor
shall any such amendment affect the terms of the Plan relating to the payment
of such Accounts in such a manner as to cause of violation of Code Section 409A.

 

Section 7.   Claims Procedure:

 

The following claims procedure shall apply with respect to the Plan:

 

4

 

7.1          Initial
claim for benefits:  Any Participant who believes he/she is
entitled to benefits or a distribution under the Plan in an amount greater than
being provided may file a claim under this Section 8.  Any such claim shall be filed in writing
stating the nature of the claim, the facts supporting the claim, the amount
claimed, and the name and address of the claimant.  Each claim shall be answered by the Company
in writing stating whether the claim is granted or denied.  Such response shall be provided within ninety
(90) days of the claim’s receipt by the Company unless an extension of time is
needed to process the claim, in which case the Company shall notify the
claimant of the need for a time extension which shall not exceed an additional
ninety (90) days.  If the claim is wholly
or partially denied, the reasons for denial and the pertinent Plan provisions
shall be set forth in the written notice to the claimant, together with an
explanation of the claimant’s appeal rights.

 

7.2          Appeals: 
Within ninety (90) days after notice that a claim is denied, the
claimant may file a written appeal to the Company, including any comments, statements,
or documents the claimant may desire to provide.  The Company shall consider the claim and
render a written decision within sixty (60) days after the appeal is timely
filed; provided, however, that, if an extension of time is needed to process
the appeal, the claimant shall be given notice of such extension which shall
not go beyond an additional sixty days (60) days.  In the event the claim is denied upon appeal,
the Company shall set forth the reasons for denial and the pertinent Plan
provisions in its written decision.  The
Company shall comply with any reasonable request from a claimant prior to
his/her filing an appeal for documents or information relevant to the claimant’s
claim.  The Company shall have
discretionary authority to determine eligibility for benefits and to construe
and apply the terms of the Plan; and any such determination or

 

5

 

construction and application shall be final and binding on all parties
unless arbitrary and capricious.

 

Section 8.   Miscellaneous Provisions:

 

8.1          Administration: 
The Company shall be responsible for the general administration and
interpretation of the Plan and for carrying out its provisions, except to the
extent all or any of such obligations are specifically imposed on the Board.

 

8.2          Set
off:  Notwithstanding any other provision of this
Plan, the Company may reduce the amount of any payment otherwise payable to or
on behalf of a Participant hereunder by the amount of any loan, cash advance,
extension of credit or other obligation of the Participant to the Company that
is then due and payable, and the Participant shall be deemed to have consented
to such reduction.

 

8.3          Continuation
of employment:  The establishment of the Plan shall not be
construed as conferring any legal or other rights upon any Participant for
continuation of employment, nor shall it interfere with the right of the
Company to discharge any Participant or to deal with him without regard to the
effect thereof under the Plan.

 

8.4          Contractual
Liability:  The obligation of the Company to make
payments hereunder shall constitute a contractual liability of the Company to
the Participant.  Such payments shall be
made from the general funds of the Company, and the Company shall not be
required to establish or maintain any special or separate fund, or otherwise to
segregate assets to assure that such payments shall be made, and the
Participant shall not have any interest in any particular assets of the Company
by reason of its obligations hereunder. 
To the extent that any person acquires a right to receive payment from
the Company, such right shall be no greater than the right of an unsecured
creditor of the Company.

 

6

 

8.5          Benefits
not assignable:  No portion of any benefit credited or paid
under the Plan with respect to any Participant shall be subject in any manner
to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance or
charge, and any attempt so to anticipate, alienate, sell, transfer, assign,
pledge, encumber or charge the same shall be void, nor shall any portion of
such benefit be in any manner payable to any assignee, receiver or any one
trustee, or be liable for his debts, contracts, liabilities, engagements or torts.

 

8.6          Payments
to minors and others:  If any individual entitled to receive a
payment under the Plan shall be physically, mentally or legally incapable of
receiving or acknowledging receipt of such payment, the Company, upon the
receipt of satisfactory evidence of his/her incapacity and satisfactory
evidence that another person or institution is maintaining him/her and that no
guardian or committee has been appointed for him/her, may cause any payment
otherwise payable to him/her to be made to such person or institution so
maintaining him/her.  Payment to such
person or institution shall be in full satisfaction of all claims by or through
the Participant to the extent of the amount thereof.

 

8.7          Code
Section 409A:  Although the Plan is intended to comply with
Code Section 409A, no guarantee is given to any Participant of the tax
treatment of any benefits under the Plan.

 

8.8          Construction: 
The provisions of the Plan shall be construed and enforced according to
the laws of the State of Wisconsin, except to the extent that such laws are
superseded by the Employee Retirement Income Security Act of 1974.

 

7Exhibit
10.15

 

QUAD/GRAPHICS,
INC.

EXECUTIVE
SALARY CONTINUATION PLAN

 

THIS AGREEMENT is made as of this         
day of                 ,
20  , by and between Quad/ Graphics, Inc., a Wisconsin
corporation (hereinafter the “Corporation”) and          hereinafter
the “Executive”).

 

BACKGROUND INFORMATION

 

The Executive is employed by the Corporation and renders valuable
services that contribute to the growth and prosperity of the Corporation.  The Corporation wishes to provide the
Executive with a salary continuation death benefit pursuant to this Agreement.

 

AGREEMENT

 

For
consideration received and the mutual promises set forth, the parties agree as
follows:

 

1.             Definitions.  For
purposes of this Agreement, the following terms have the meanings set forth below:

 

(a)                                  Beneficiary means a
surviving spouse and/or Dependent Children (including a trust established for
the surviving spouse and/or dependent children) designated by the Executive to
receive any benefit under the Agreement following [his/her] death.  A Participant shall make the initial
designation through a beneficiary designation the Participant provides to the
Corporation.  The Participant may change
his Beneficiary as provided in Section 4.

 

(b)                                 Contingent
Beneficiary means the surviving spouse and/or Dependent
Children (including a trust established for the surviving spouse and/or
Dependent Children) designated by the Participant, as provided in Section 4,
to receive any benefits under this Agreement in the event the Beneficiary does
not survive the Participant.  Any
reference to a “Beneficiary” in the Agreement shall be deemed to include the
Contingent Beneficiary if the context so indicates.

 

(c)                                  Dependent Child
means

 

a.               the
unmarried, natural born child of the employee under the age of 25 years; or

 

b.              the
unmarried adopted child of the employee under the age of 25 years.

 

(d)                                 Executive means the
individual named above who has been approved by the Quad/Graphics, Inc.
Board of Directors to receive the benefits

 

 

provided under this Agreement and who is a Corporate Vice President or
President.

 

(e)                                  Final Base
Earnings means the amount of regular earnings paid as
compensation by the Corporation to the Executive at the time of the Executive’s
death.  Final Base Earnings does not
include any other earning or compensation including, but not limited to bonus,
options or incentives paid to Executive.

 

(f)                                    Retirement Date means the date
that the Executive terminates employment with the Corporation at a time when
he/she has attained the age of 55.

 

2.             Termination.  If the Executive’s employment with the
Corporation is terminated for any reason other than death prior to the
Executive’s Retirement Date, the Executive, his designated Beneficiary or any
other person or persons shall not have any right to receive any death benefits
under this Agreement.

 

3.             Benefits.

 

(a)                                  If the
Executive dies after attaining age 55 but before [his/her] Retirement Date, the
Corporation shall pay to the Beneficiary an amount equal to 60% of [his/her]
Final Base Earnings, in equal monthly installments beginning as soon as
administratively possible after the Executive’s death and continuing for a
period to end on the earlier of:

 

(1)                                  the date on
which the Executive would have become 65 years of age; or

 

(2)                                  the later of :

 

i.      the 25th birthday of the youngest of the Executive’s
surviving Dependent Children; or

 

ii.     the death of the surviving
spouse.

 

(b)                                 If the
Executive dies before attaining age 55, the Corporation shall pay to the
Beneficiary an amount equal to 60% of [his/her] Final Base Earnings in equal
monthly installments beginning as soon as administratively possible after the
Executive’s death and continue for a period to end on the earlier of:

 

(1)                                  the tenth
anniversary of the Executive’s death; or

 

(2)                                  the later of:

 

i.      the 25th birthday of the youngest of the Executive’s
surviving Dependent Children; or

 

2

 

ii.     the death of the surviving
spouse.

 

(c)                                  If the Executive leaves no
surviving Dependent Children under the age of 25 and no surviving spouse, no
death benefits are provided under this Agreement.

 

4.             Beneficiary.  The Executive shall have the right to
designate in writing one or more Beneficiaries or Contingent Beneficiaries to
receive the payments provided for in Section 3 of this Agreement.  The Executive shall be permitted to change
[his/her] Beneficiary designation so long as such change is consistent with Section 1
above.  If the Executive fails to
designate a Beneficiary, or the Beneficiary is deemed incompetent by a court of
law, then the Corporation shall pay said amounts to the surviving spouse.  If the Executive leaves no surviving spouse,
then, the Corporation shall pay said amounts equally, according to the Uniform
Transfers to Minors Act, for the benefit of Executive’s Dependent Children.

 

5.             Restrictions.  Notwithstanding anything contained in this
Agreement to the contrary, no payment shall be made and all rights under this
Agreement of the Executive, [his/her] designated Beneficiary, executors or
administrators, or any other person, to receive payments under this Agreement
shall be forfeited if the Executive dies by self-inflicted injury, whether sane
or insane.

 

6.             Insurance.  If the Corporation elects to purchase a life
insurance policy on the life of the Executive to provide the Corporation with
the funds required to make payments under this Agreement, the Corporation shall
at all times be the sole and complete owner and beneficiary of such policy and
shall have the unrestricted right to use all amounts and exercise all options
and privileges under the policy without the knowledge or consent of the
Executive or his designated Beneficiary or any other person.  It is expressly agreed that neither the
Executive nor his designated Beneficiary nor any other person shall have any
right, title or interest whatsoever in or to any such policy.

 

7.             Assignment.  Neither the Executive nor his designated
Beneficiary nor any other person entitled to payments under this Agreement
shall have the power to transfer, assign, anticipate, mortgage or otherwise
encumber in advance of any such payments, nor shall such payments be subject to
seizure for the payment of public or private debts, judgments, alimony, or
separate maintenance, or be transferable by operation of law in event of
bankruptcy, insolvency or otherwise.

 

8.             Unsecured
Promise.  The
Executive and any other person or persons having or claiming a right to
payments under this Agreement or to any interest in this Agreement shall rely
solely on the unsecured promise of the Corporation set forth in this
Agreement.  Nothing in this Agreement
shall be construed to give the Executive or any other person or persons any
right, title, interest or claim in or to any specific asset, fund, reserve,
account or property of any kind whatsoever owned by the Corporation or in which
it may have any right, title or interest now or in the future.  The Executive or any person claiming a right
to payments under this Agreement shall have the right to enforce his or her
claim against the Corporation in the same manner as any unsecured creditor.

 

3

 

9.             No Right to
Employment.  Nothing
contained in this Agreement shall be construed as conferring upon the Executive
the right to continue in the employ of the Corporation.  The Corporation or the Executive may
terminate the Executive’s employment at any time and for any reason with or
without notice.

 

10.          Amendment or
Termination of Agreement.  This Agreement may be amended or terminated
unilaterally by the Corporation at any time or from time to time, with or
without notice.

 

11.          Previous
Agreements.  This
Agreement replaces and supersedes all other similar or related booklets,
handbooks, documents and agreements.

 

12.          ERISA.  The following provisions are intended to meet
the requirements of the Employee Retirement Income Security Act of 1974, as
amended (ERISA).

 

(a)                                  Named Fiduciary
and Plan Administrator.  The
Corporation is the named fiduciary and Plan Administrator for this
Agreement.  The Plan Administrator shall
have full discretionary authority to interpret and apply all provisions of this
Agreement, including, but not limited to, all issues concerning eligibility for
and determination of benefits.  Decisions
of the Plan Administrator, made in good faith, shall be final and binding.

 

(b)                                 Filing of a
Claim for Benefits.  The
Executive’s designated Beneficiary shall make a claim for the benefits provided
under this Agreement by delivering a written request to the Plan Administrator.

 

(c)                                  Notification of
Claimant of Decision.  The Plan
Administrator shall notify the designated Beneficiary (“Claimant”) in writing,
within 45 days of his or her written application for benefits, of his or her
eligibility or ineligibility for benefits under this Agreement.  If the Plan Administrator determines that a
Claimant is not eligible for benefits or full benefits, the notice shall set
forth:

 

(1)                                  The specific
reasons for such denial,

 

(2)                                  A specific
reference to the provisions of the Agreement on which the denial is based,

 

(3)                                  A description
of any additional information or material necessary for the Claimant to perfect
his or her claim, and a description of why it is needed, and

 

(4)                                  An explanation
of the claims review procedure and the time limits applicable to such procedures,
including a statement of the Claimant’s right to bring a civil action under
section 502(a) of ERISA following an adverse benefit determination on
review.

 

4

 

If
the Plan Administrator determines that there are special circumstances
requiring additional time to make a decision, the Plan Administrator shall
notify the claimant of the special circumstances and of the date by which a
decision is expected to be made, and may extend the time for up to an additional
30-day period.

 

(d)                                 Review
Procedure.  If a
Claimant is determined by the Plan Administrator to be ineligible for benefits,
or if the Claimant believes that he or she is entitled to greater or different
benefits, the Claimant shall have the opportunity to have such claim reviewed
by the Plan Administrator by filing a petition for review with the Plan
Administrator within 180 days after receipt of the notice issued by the Plan
Administrator.  The petition shall state
the specific reasons why the Claimant believes that he or she is entitled to
benefits, greater benefits, or different benefits.  Within 45 days after receipt by the Plan
Administrator of the petition, the Plan Administrator shall afford the Claimant
(and counsel, if any) an opportunity to present his or her position to the Plan
Administrator orally or in writing, and the Claimant (or counsel) shall have
the right to review the pertinent documents. 
Within the 45-day period, the Plan Administrator shall notify the
Claimant of its decision in writing.  The
Plan Administrator’s written notice to the Claimant shall set forth
specifically:

 

(1)                                  The basis of the Plan Administrator’s
decision;

 

(2)                                  The specific provisions of the Agreement
on which the decision is based;

 

(3)                                  A statement that the Claimant is entitled
to receive, upon request and free of charge, reasonable access to, and copies
of all documents, records, and other information relevant to the Claimant’s
claim for benefits; and

 

(4)                                  A statement of the Claimant’s right to
bring an action under section 502(a) of ERISA.

 

If, because of the need for a hearing, the 45-day
period is not sufficient, the decision may be deferred for up to another 45-day
period at the election of the Plan Administrator, but notice of this deferral
shall be given to the Claimant.

 

13.          Limitation
on Actions Against the Corporation.  A Claimant must complete the Review Procedure
set forth in section 12(d) before he or she may bring legal action against
the Corporation for benefits pursuant to this Agreement.  No legal action may be commenced against the
Corporation more than 90 days after the Claimant receives notice of the Plan
Administrator’s final decision on his or her appeal.

 

5

 

IN WITNESS WHEREOF, the parties have made this
Agreement this            day
of                                         ,
20      .

 

 

	
  EXECUTIVE

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
  [Name
  of Executive]

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
  QUAD/GRAPHICS,
  INC.

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
  [Name and Title of Officer]

  	
   

  

 

6

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