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eb DE ee ig ne DOOR 8 see ‘ews Tae 16. df na witness is otherwise available, the Government Officer receiving this application in person shall serve as such witness upon request. Mailed applications MUST be signed by a witness as well as by the applicant. b6 b7C Signature Witnessed By: a bé b7¢ or, Thility of Such Person Relative to Proposed Demonstration bé b7C Telephone Numbers of Witness bef vening Telephone Numbers of Person Piling NOTE: Under 18 U.S.C. 1001, any person who knowingly and willfully faisifies, conceals, or covers up by any trick, scheme, or device a material fact, or makes any false statements or representations, in respect of any matter within the jurisdiction of any department or agency of the United States, is liable to a fine in an amount up to $16,000, and imprisonment for not more than five years, or both. b6 b7C