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                                                          N. 2
                                           
                                           
                                               
                                             
                                                   
   
                                     
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                          "__"___________ 20__ .
   
      __________________________________________
    +---------------------------------------------------------------------------------+
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                                         .      %  )   
                                        (. )                   
    +---+---------+---------------+---------+-------------+---------+------+----------
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    +---+---------+---------------+---------+-------------+---------+------+----------
                                                                              
                                                                              
                                                                              
                                                                              
                                                                              
                                                                              
                                                                              
                                                                              
                                                                              
                                                                              
                                                                              
    +---------------------------------------------------------------------------------+
   
                   ______________________
   
           ______________________
   
         "__"_________ 20__ .
   
               ..