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FICTITIOUS NAME STATBTE AFFIDl~?VIT
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Print fictitious name af business on this line
STATE OF TEXAS
CQUNTY OF HARRIS
pn this ciay personally appeared before me, an officer duly autharized to administer oaths,
Keith E. Eastin~.. Vice___President of NA'I`IONAL C4NVENISNCE ST~RES
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INCORPORATSD, a Texas corporatian ~
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who, being first duly sworn, depose8..... and say--&..........:
Zye names of all the persons interested in the business conducted under the foregoing fio-
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a•~ T~~_, and the extent of the interest of each of them in said business is as follows: ~
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g~~p~:-~q~d subscribed before me
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':'`;~1~~' , , day of 19.7~_...
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~ ''~ic in and for Harris County, Texas
z- ' ~ : = fILEO ANO RE
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--'~~'=t~`;~~' •`''L ~ CLERK CIRCUITCOIJRT
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