John Ellson v. Union Pacific Railroad

• Court: District Court, C.D. California
• Decided: March 2, 2023
• Docket: 5:22-cv-01767
• Status: Unknown

Opinion

Case 5:22-cv-01767-SSS-SP Document 27 Filed 03/02/23 Page 1 of 15 Page ID #:418

1 ALFRED SHAUMYAN (SBN 266908) alfred@sdalawgroup.com 2 AREN DERBARSEGHIAN (SBN 304530) 3 aren@sdalawgroup.com AMIR ABDIZADEH (SBN 298114) 4 amir@sdalawgroup.com SDA LAW GROUP P.C. 5 535 N. Brand Blvd, Suite #280 Glendale, California 91203 6 Telephone: (818) 574-0845

7 Attorney for Plaintiff JOHN ELLSON 8 JOANNA E. MACMILLAN (SBN 281891) 9 jmacmillan@constangy.com AYAN K. JACOBS (SBN 329934) 10 ajacobs@constangy.com CONSTANGY, BROOKS, 11 SMITH & PROPHETE, LLP 2029 Century Park East, Suite 1100 12 Los Angeles, California 90067 Telephone: (310) 909-7775 13 Attorneys for Defendant 14 UNION PACIFIC RAILROAD

15 UNITED STATES DISTRICT COURT 16 CENTRAL DISTRICT OF CALIFORNIA 17 18 JOHN ELLSON, an individual Case No. 5:22-CV-01767-SSS-SPx Plaintiff, 19 v.

20 UNION PACIFIC RAILROAD ORDER RE: JOINT STIPULATED COMPANY, a Delaware Corporation, PROTECTIVE ORDER 21 and DOES 1-50, 22 Defendants.

25 26 27 28 1

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1 1. A. PURPOSES AND LIMITATIONS 2 Discovery in this action is likely to involve production of confidential, 3 proprietary or private information for which special protection from public disclosure 4 and from use for any purpose other than prosecuting this litigation may be warranted. 5 Accordingly, the parties hereby stipulate to and petition the Court to enter the following 6 Stipulated Protective Order. The parties acknowledge that this Order does not confer 7 blanket protections on all disclosures or responses to discovery and that the protection 8 it affords from public disclosure and use extends only to the limited information or items 9 that are entitled to confidential treatment under the applicable legal principles. 10 B. GOOD CAUSE STATEMENT 11 This action is likely to involve personnel records, employment information, and 12 healthcare and medical records, including protected health information covered by 13 HIPAA, for which special protection from public disclosure and from use for any 14 purpose other than prosecution of this action is warranted. Such information may 15 consist of, among other things, leave and disability accommodation information and 16 payroll information. Federal courts have recognized the privacy protection accorded to 17 a person’s personnel records and employment information under Article 1, Section 1 of 18 the California Constitution. See, e.g., Bickley v. Schneider Nat’l, Inc., No. C 08–5806 19 JSW (JL), 2011 WL 1344195, at *2 (N.D.Cal.2011) (unpublished) (collecting cases and 20 stating that “[a]n employee's personnel records and employment information are 21 protected by the constitutional right to privacy”); Official Unsecured Creditors Comm. 22 of Media Vision Tech., Inc. v. Jain, 215 F.R.D. 587, 590 (N.D.Cal.2003). Courts have 23 also found good cause to issue a protective order when medical information may be 24 subject to disclosure. See, e.g., Tenney v. Aetna Life Ins. Co., No. 25 817CV00387CJCKESX, 2017 WL 8186684, at *4 (C.D. Cal. Dec. 29, 2017). 26 Accordingly, to expedite the flow of information, to facilitate the prompt 27 resolution of disputes over confidentiality of discovery materials, to adequately protect 28 information the parties are entitled to keep confidential, to ensure that the parties are 2

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1 permitted reasonable necessary uses of such material in preparation for and in the 2 conduct of trial, to address their handling at the end of the litigation, and serve the ends 3 of justice, a protective order for such information is justified in this matter. It is the 4 intent of the parties that information will not be designated as confidential for tactical 5 reasons and that nothing be so designated without a good faith belief that it has been 6 maintained in a confidential, non-public manner, and there is good cause why it should 7 not be part of the public record of this case. 8 C. ACKNOWLEDGMENT OF PROCEDURE FOR FILING UNDER SEAL 9 The parties further acknowledge, as set forth in Section 12.3, below, that this 10 Stipulated Protective Order does not entitle them to file confidential information under 11 seal; Local Civil Rule 79-5 sets forth the procedures that must be followed and the 12 standards that will be applied when a party seeks permission from the court to file 13 material under seal. 14 There is a strong presumption that the public has a right of access to judicial 15 proceedings and records in civil cases. In connection with non-dispositive motions, 16 good cause must be shown to support a filing under seal. See Kamakana v. City and 17 County of Honolulu, 447 F.3d 1172, 1176 (9th Cir. 2006), Phillips v. Gen. Motors 18 Corp., 307 F.3d 1206, 1210-11 (9th Cir. 2002), Makar-Welbon v. Sony Electrics, Inc., 19 187 F.R.D. 576, 577 (E.D. Wis. 1999) (even stipulated protective orders require good 20 cause showing), and a specific showing of good cause or compelling reasons with 21 proper evidentiary support and legal justification, must be made with respect to 22 Protected Material that a party seeks to file under seal. The parties’ mere designation 23 of Disclosure or Discovery Material as CONFIDENTIAL does not—without the 24 submission of competent evidence by declaration, establishing that the material sought 25 to be filed under seal qualifies as confidential, privileged, or otherwise protectable— 26 constitute good cause. 27 Further, if a party requests sealing related to a dispositive motion or trial, then 28 compelling reasons, not only good cause, for the sealing must be shown, and the relief 3

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1 sought shall be narrowly tailored to serve the specific interest to be protected. See 2 Pintos v. Pacific Creditors Ass’n, 605 F.3d 665, 677-79 (9th Cir. 2010). For each item 3 or type of information, document, or thing sought to be filed or introduced under seal 4 in connection with a dispositive motion or trial, the party seeking protection must 5 articulate compelling reasons, supported by specific facts and legal justification, for the 6 requested sealing order. Again, competent evidence supporting the application to file 7 documents under seal must be provided by declaration. 8 Any document that is not confidential, privileged, or otherwise protectable in its 9 entirety will not be filed under seal if the confidential portions can be redacted. If 10 documents can be redacted, then a redacted version for public viewing, omitting only 11 the confidential, privileged, or otherwise protectable portions of the document, shall be 12 filed. Any application that seeks to file documents under seal in their entirety should 13 include an explanation of why redaction is not feasible. 14 2. DEFINITIONS 15 2.1 Action: the above-captioned lawsuit, i.e., Ellson v. Union Pacific Railroad 16 Company et al., Case No. 5:22-CV-01767-SSS-SP (C.D. Cal.). 17 2.2 Challenging Party: a Party or Non-Party that challenges the designation 18 of information or items under this Order. 19 2.3 “CONFIDENTIAL” Information or Items: information (regardless of how 20 it is generated, stored or maintained) or tangible things that qualify for protection under 21 Federal Rule of Civil Procedure 26(c), and as specified above in the Good Cause 22 Statement. 23 2.4 Counsel: Outside Counsel of Record and House Counsel (as well as their 24 support staff). 25 2.5 Designating Party: a Party or Non-Party that designates information or 26 items that it produces in disclosures or in responses to discovery as 27 “CONFIDENTIAL.” 28 /// 4

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1 2.6 Disclosure or Discovery Material: all items or information, regardless of 2 the medium or manner in which it is generated, stored, or maintained (including, among 3 other things, testimony, transcripts, and tangible things), that are produced or generated 4 in disclosures or responses to discovery in this matter. 5 2.7 Expert: a person with specialized knowledge or experience in a matter 6 pertinent to the litigation who has been retained by a Party or its counsel to serve as an 7 expert witness or as a consultant in this Action. 8 2.8 House Counsel: attorneys who are employees of a party to this Action. 9 House Counsel does not include Outside Counsel of Record or any other outside 10 counsel. 11 2.9 Non-Party: any natural person, partnership, corporation, association or 12 other legal entity not named as a Party to this action. 13 2.10 Outside Counsel of Record: attorneys who are not employees of a party to 14 this Action but are retained to represent or advise a party to this Action and have 15 appeared in this Action on behalf of that party or are affiliated with a law firm that has 16 appeared on behalf of that party, and includes support staff. 17 2.11 Party: any party to this Action, including all of its officers, directors, 18 employees, consultants, retained experts, and Outside Counsel of Record (and their 19 support staffs). 20 2.12 Producing Party: a Party or Non-Party that produces Disclosure or 21 Discovery Material in this Action. 22 2.13 Professional Vendors: persons or entities that provide litigation support 23 services (e.g., photocopying, videotaping, translating, preparing exhibits or 24 demonstrations, and organizing, storing, or retrieving data in any form or medium) and 25 their employees and subcontractors. 26 2.14 Protected Material: any Disclosure or Discovery Material that is 27 designated as “CONFIDENTIAL.” 28 /// 5

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1 2.15 Receiving Party: a Party that receives Disclosure or Discovery Material 2 from a Producing Party. 3 3. SCOPE 4 The protections conferred by this Stipulation and Order cover not only Protected 5 Material (as defined above), but also (1) any information copied or extracted from 6 Protected Material; (2) all copies, excerpts, summaries, or compilations of Protected 7 Material; and (3) any testimony, conversations, or presentations by Parties or their 8 Counsel that might reveal Protected Material. 9 Any use of Protected Material at trial shall be governed by the orders of the trial 10 judge. This Order does not govern the use of Protected Material at trial. 11 4. DURATION 12 Even after final disposition of this litigation, the confidentiality obligations 13 imposed by this Order will remain in effect until a Designating Party agrees otherwise 14 in writing or a court order otherwise directs. Final disposition is the latter of (1) 15 dismissal of all claims and defenses in this action, with or without prejudice, or (2) final 16 judgment after the completion and exhaustion of all appeals, rehearings, remands, trials, 17 or reviews of this action, including the time limits for filing any motions or applications 18 for extension of time under applicable law. 19 5. DESIGNATING PROTECTED MATERIAL 20 5.1 Exercise of Restraint and Care in Designating Material for Protection. 21 Each Party or Non-Party that designates information or items for protection under this 22 Order must take care to limit any such designation to specific material that qualifies 23 under the appropriate standards. The Designating Party must designate for protection 24 only those parts of material, documents, items or oral or written communications that 25 qualify so that other portions of the material, documents, items or communications for 26 which protection is not warranted are not swept unjustifiably within the ambit of this 27 Order. 28 /// 6

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1 Mass, indiscriminate or routinized designations are prohibited. Designations that 2 are shown to be clearly unjustified or that have been made for an improper purpose 3 (e.g., to unnecessarily encumber the case development process or to impose 4 unnecessary expenses and burdens on other parties) may expose the Designating Party 5 to sanctions. 6 If it comes to a Designating Party’s attention that information or items that it 7 designated for protection do not qualify for protection, that Designating Party must 8 promptly notify all other Parties that it is withdrawing the inapplicable designation. 9 5.2 Manner and Timing of Designations. Except as otherwise provided in this 10 Order (see, e.g., second paragraph of section 5.2(a) below), or as otherwise stipulated 11 or ordered, Disclosure or Discovery Material that qualifies for protection under this 12 Order must be clearly so designated before the material is disclosed or produced. 13 Designation in conformity with this Order requires: 14 (a) for information in documentary form (e.g., paper or electronic documents, 15 but excluding transcripts of depositions or other pretrial or trial proceedings), that the 16 Producing Party affix at a minimum, the legend “CONFIDENTIAL” (hereinafter 17 “CONFIDENTIAL legend”), to each page that contains protected material. If only a 18 portion of the material on a page qualifies for protection, the Producing Party also must 19 clearly identify the protected portion(s) (e.g., by making appropriate markings in the 20 margins). 21 A Party or Non-Party that makes original documents available for inspection 22 need not designate them for protection until after the inspecting Party has indicated 23 which documents it would like copied and produced. During the inspection and before 24 the designation, all of the material made available for inspection shall be deemed 25 “CONFIDENTIAL.” After the inspecting Party has identified the documents it wants 26 copied and produced, the Producing Party must determine which documents, or portions 27 thereof, qualify for protection under this Order. Then, before producing the specified 28 documents, the Producing Party must affix the “CONFIDENTIAL legend” to each page 7

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1 that contains Protected Material. If only a portion of the material on a page qualifies 2 for protection, the Producing Party also must clearly identify the protected portion(s) 3 (e.g., by making appropriate markings in the margins). 4 (b) for testimony given in depositions that the Designating Party identifies 5 the Disclosure or Discovery Material on the record, before the close of the deposition 6 all protected testimony. 7 (c) for information produced in some form other than documentary and for 8 any other tangible items, that the Producing Party affix in a prominent place on the 9 exterior of the container or containers in which the information is stored the legend 10 “CONFIDENTIAL.” If only a portion or portions of the information warrants 11 protection, the Producing Party, to the extent practicable, shall identify the protected 12 portion(s). 13 5.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent 14 failure to designate qualified information or items does not, standing alone, waive the 15 Designating Party’s right to secure protection under this Order for such material. Upon 16 timely correction of a designation, the Receiving Party must make reasonable efforts to 17 assure that the material is treated in accordance with the provisions of this Order. 18 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS 19 6.1 Timing of Challenges. Any Party or Non-Party may challenge a 20 designation of confidentiality at any time that is consistent with the Court’s Scheduling 21 Order. 22 6.2 Meet and Confer. The Challenging Party shall initiate the dispute 23 resolution process under Local Rule 37.1 et seq. 24 6.3 The burden of persuasion in any such challenge proceeding shall be on the 25 Designating Party. Frivolous challenges, and those made for an improper purpose (e.g., 26 to harass or impose unnecessary expenses and burdens on other parties) may expose the 27 Challenging Party to sanctions. Unless the Designating Party has waived or withdrawn 28 the confidentiality designation, all parties shall continue to afford the material in 8

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1 question the level of protection to which it is entitled under the Producing Party’s 2 designation until the Court rules on the challenge. 3 7. ACCESS TO AND USE OF PROTECTED MATERIAL 4 7.1 Basic Principles. A Receiving Party may use Protected Material that is 5 disclosed or produced by another Party or by a Non-Party in connection with this Action 6 only for prosecuting, defending or attempting to settle this Action. Such Protected 7 Material may be disclosed only to the categories of persons and under the conditions 8 described in this Order. When the Action has been terminated, a Receiving Party must 9 comply with the provisions of section 13 below (FINAL DISPOSITION). 10 Protected Material must be stored and maintained by a Receiving Party at a 11 location and in a secure manner that ensures that access is limited to the persons 12 authorized under this Order. 13 7.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless otherwise 14 ordered by the court or permitted in writing by the Designating Party, a Receiving Party 15 may disclose any information or item designated “CONFIDENTIAL” only to: 16 (a) the Receiving Party’s Outside Counsel of Record in this Action, as well 17 as employees of said Outside Counsel of Record to whom it is reasonably necessary to 18 disclose the information for this Action; 19 (b) the officers, directors, and employees (including House Counsel) of the 20 Receiving Party to whom disclosure is reasonably necessary for this Action; 21 (c) Experts (as defined in this Order) of the Receiving Party to whom 22 disclosure is reasonably necessary for this Action and who have signed the 23 “Acknowledgment and Agreement to Be Bound” (Exhibit A); 24 (d) the court and its personnel; 25 (e) court reporters and their staff; 26 (f) professional jury or trial consultants, mock jurors, and Professional 27 Vendors to whom disclosure is reasonably necessary for this Action and who have 28 signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A); 9

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1 (g) the author or recipient of a document containing the information or a 2 custodian or other person who otherwise possessed or knew the information; 3 (h) during their depositions, witnesses, and attorneys for witnesses, in the 4 Action to whom disclosure is reasonably necessary provided: (1) the deposing party 5 requests that the witness sign the form attached as Exhibit 1 hereto; and (2) they will 6 not be permitted to keep any confidential information unless they sign the 7 “Acknowledgment and Agreement to Be Bound” (Exhibit A), unless otherwise agreed 8 by the Designating Party or ordered by the court. Pages of transcribed deposition 9 testimony or exhibits to depositions that reveal Protected Material may be separately 10 bound by the court reporter and may not be disclosed to anyone except as permitted 11 under this Stipulated Protective Order; and 12 (i) any mediator or settlement officer, and their supporting personnel, 13 mutually agreed upon by any of the parties engaged in settlement discussions. 14 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED IN 15 OTHER LITIGATION 16 If a Party is served with a subpoena or a court order issued in other litigation that 17 compels disclosure of any information or items designated in this Action as 18 “CONFIDENTIAL,” that Party must: 19 (a) promptly notify in writing the Designating Party. Such notification shall 20 include a copy of the subpoena or court order; 21 (b) promptly notify in writing the party who caused the subpoena or order to 22 issue in the other litigation that some or all of the material covered by the subpoena or 23 order is subject to this Protective Order. Such notification shall include a copy of this 24 Stipulated Protective Order; and 25 (c) cooperate with respect to all reasonable procedures sought to be pursued 26 by the Designating Party whose Protected Material may be affected. 27 If the Designating Party timely seeks a protective order, the Party served with the 28 subpoena or court order shall not produce any information designated in this action as 10

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1 “CONFIDENTIAL” before a determination by the court from which the subpoena or 2 order issued, unless the Party has obtained the Designating Party’s permission. The 3 Designating Party shall bear the burden and expense of seeking protection in that court 4 of its confidential material and nothing in these provisions should be construed as 5 authorizing or encouraging a Receiving Party in this Action to disobey a lawful directive 6 from another court. 7 9. A NON-PARTY’S PROTECTED MATERIAL SOUGHT TO BE PRODUCED 8 IN THIS LITIGATION 9 (a) The terms of this Order are applicable to information produced by a Non- 10 Party in this Action and designated as “CONFIDENTIAL.” Such information produced 11 by Non-Parties in connection with this litigation is protected by the remedies and relief 12 provided by this Order. Nothing in these provisions should be construed as prohibiting 13 a Non-Party from seeking additional protections. 14 (b) In the event that a Party is required, by a valid discovery request, to 15 produce a Non-Party’s confidential information in its possession, and the Party is 16 subject to an agreement with the Non-Party not to produce the Non-Party’s confidential 17 information, then the Party shall: 18 (1) promptly notify in writing the Requesting Party and the Non-Party that 19 some or all of the information requested is subject to a confidentiality agreement with 20 a Non-Party; 21 (2) promptly provide the Non-Party with a copy of the Stipulated 22 Protective Order in this Action, the relevant discovery request(s), and a reasonably 23 specific description of the information requested; and 24 (3) make the information requested available for inspection by the Non- 25 Party, if requested. 26 (c) If the Non-Party fails to seek a protective order from this court within 21 27 days of receiving the notice and accompanying information, the Receiving Party may 28 produce the Non-Party’s confidential information responsive to the discovery request. 11

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1 If the Non-Party timely seeks a protective order, the Receiving Party shall not produce 2 any information in its possession or control that is subject to the confidentiality 3 agreement with the Non-Party before a determination by the court. Absent a court order 4 to the contrary, the Non-Party shall bear the burden and expense of seeking protection 5 in this court of its Protected Material. 6 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL 7 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed 8 Protected Material to any person or in any circumstance not authorized under this 9 Stipulated Protective Order, the Receiving Party must immediately (a) notify in writing 10 the Designating Party of the unauthorized disclosures, (b) use its best efforts to retrieve 11 all unauthorized copies of the Protected Material, (c) inform the person or persons to 12 whom unauthorized disclosures were made of all the terms of this Order, and (d) request 13 such person or persons to execute the “Acknowledgment and Agreement to Be Bound” 14 that is attached hereto as Exhibit A. 15 11. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE 16 PROTECTED MATERIAL 17 When a Producing Party gives notice to Receiving Parties that certain 18 inadvertently produced material is subject to a claim of privilege or other protection, 19 the obligations of the Receiving Parties are those set forth in Federal Rule of Civil 20 Procedure 26(b)(5)(B). This provision is not intended to modify whatever procedure 21 may be established in an e-discovery order that provides for production without prior 22 privilege review. Pursuant to Federal Rule of Evidence 502(d) and (e), insofar as the 23 parties reach an agreement on the effect of disclosure of a communication or 24 information covered by the attorney-client privilege or work product protection, the 25 parties may incorporate their agreement in the stipulated protective order submitted to 26 the court. 27 /// 28 /// 12

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1 12. MISCELLANEOUS 2 12.1 Right to Further Relief. Nothing in this Order abridges the right of any 3 person to seek its modification by the Court in the future. 4 12.2 Right to Assert Other Objections. By stipulating to the entry of this 5 Protective Order, no Party waives any right it otherwise would have to object to 6 disclosing or producing any information or item on any ground not addressed in this 7 Stipulated Protective Order. Similarly, no Party waives any right to object on any 8 ground to use in evidence of any of the material covered by this Protective Order. 9 12.3 Filing Protected Material. A Party that seeks to file under seal any 10 Protected Material must comply with Local Civil Rule 79-5. Protected Material may 11 only be filed under seal pursuant to a court order authorizing the sealing of the specific 12 Protected Material at issue. If a Party’s request to file Protected Material under seal is 13 denied by the court, then the Receiving Party may file the information in the public 14 record unless otherwise instructed by the court. 15 13. FINAL DISPOSITION 16 After the final disposition of this Action, as defined in paragraph 4, within 60 17 days of a written request by the Designating Party, each Receiving Party must return all 18 Protected Material to the Producing Party or destroy such material. As used in this 19 subdivision, “all Protected Material” includes all copies, abstracts, compilations, 20 summaries, and any other format reproducing or capturing any of the Protected 21 Material. Whether the Protected Material is returned or destroyed, the Receiving Party 22 must submit a written certification to the Producing Party (and, if not the same person 23 or entity, to the Designating Party) by the 60 day deadline that (1) identifies (by 24 category, where appropriate) all the Protected Material that was returned or destroyed 25 and (2) affirms that the Receiving Party has not retained any copies, abstracts, 26 compilations, summaries or any other format reproducing or capturing any of the 27 Protected Material. Notwithstanding this provision, Counsel are entitled to retain an 28 archival copy of all pleadings, motion papers, trial, deposition, and hearing transcripts, 13

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1 || legal memoranda, correspondence, deposition and trial exhibits, expert reports, attorney 2 || work product, and consultant and expert work product, even if such materials contain 3 || Protected Material. Any such archival copies that contain or constitute Protected 4 || Material remain subject to this Protective Order as set forth in Section 4 (DURATION). 5 VIOLATION 6 || Any willful violation of this Order may be punished by civil or criminal contempt, 7 ||financial or evidentiary sanctions, reference to disciplinary authorities, or other 8 || appropriate action at the discretion of the Court. 10 ||) IT IS SO ORDERED. 11 D DATED: March 2, 2023 HON. SUNSHINE S. SYKES 13 U.S. DISTRICT JUDGE 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

ORDER RE STIPULATION AND PROTECTIVE ORDER

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EXHIBIT A 1 2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND 3 I, _____________________________ [print or type full name], of 4 _________________ [print or type full address], declare under penalty of perjury that I 5 have read in its entirety and understand the Stipulated Protective Order that was issued 6 by the United States District Court for the Central District of California on [date] in the 7 case of Ellson v. Union Pacific Railroad Company, et al., Case No. 5:22-CV-01767- 8 SSS-SP (C.D. Cal.). I agree to comply with and to be bound by all the terms of this 9 Stipulated Protective Order and I understand and acknowledge that failure to so comply 10 could expose me to sanctions and punishment in the nature of contempt. I solemnly 11 promise that I will not disclose in any manner any information or item that is subject to 12 this Stipulated Protective Order to any person or entity except in strict compliance with 13 the provisions of this Order. 14 I further agree to submit to the jurisdiction of the United States District Court for the 15 Central District of California for enforcing the terms of this Stipulated Protective Order, 16 even if such enforcement proceedings occur after termination of this action. I hereby 17 appoint __________________________ [print or type full name] of 18 _______________________________________ [print or type full address and 19 telephone number] as my California agent for service of process in connection with this 20 action or any proceedings related to enforcement of this Stipulated Protective Order. 21 22 Date: ___________________________ 23 24 City and State where sworn and signed:

25 Printed name: _______________________________ 26

27 Signature: __________________________________

28 15