ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

Page 1 <img data-url='document/prosites-inc-2014-08-27-general-and-cosmetic-dentistry-8770-cuyamaca-street.html?page=1' data-page='1' class='cut-thumb lazyload' alt='Page 1: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050120/5f50ee4770905843797a2087/html5/thumbnails/1.jpg' width='140' height='200' /> Page 2 <img data-url='document/prosites-inc-2014-08-27-general-and-cosmetic-dentistry-8770-cuyamaca-street.html?page=2' data-page='2' class='cut-thumb lazyload' alt='Page 2: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050120/5f50ee4770905843797a2087/html5/thumbnails/2.jpg' width='140' height='200' /> Page 3 <img data-url='document/prosites-inc-2014-08-27-general-and-cosmetic-dentistry-8770-cuyamaca-street.html?page=3' data-page='3' class='cut-thumb lazyload' alt='Page 3: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050120/5f50ee4770905843797a2087/html5/thumbnails/3.jpg' width='140' height='200' /> Page 4 <img data-url='document/prosites-inc-2014-08-27-general-and-cosmetic-dentistry-8770-cuyamaca-street.html?page=4' data-page='4' class='cut-thumb lazyload' alt='Page 4: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050120/5f50ee4770905843797a2087/html5/thumbnails/4.jpg' width='140' height='200' /> Page 5 <img data-url='document/prosites-inc-2014-08-27-general-and-cosmetic-dentistry-8770-cuyamaca-street.html?page=5' data-page='5' class='cut-thumb lazyload' alt='Page 5: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050120/5f50ee4770905843797a2087/html5/thumbnails/5.jpg' width='140' height='200' /> Page 6 <img data-url='document/prosites-inc-2014-08-27-general-and-cosmetic-dentistry-8770-cuyamaca-street.html?page=6' data-page='6' class='cut-thumb lazyload' alt='Page 6: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050120/5f50ee4770905843797a2087/html5/thumbnails/6.jpg' width='140' height='200' /> Page 7 <img data-url='document/prosites-inc-2014-08-27-general-and-cosmetic-dentistry-8770-cuyamaca-street.html?page=7' data-page='7' class='cut-thumb lazyload' alt='Page 7: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050120/5f50ee4770905843797a2087/html5/thumbnails/7.jpg' width='140' height='200' />

ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

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